Two-year cost comparison of vertebroplasty and kyphoplasty for the treatment of vertebral compression fractures: are initial surgical costs misleading?
Rent the article at a discountRent now
* Final gross prices may vary according to local VAT.Get Access
The costs for treating kypho- and vertebroplasty patients were evaluated at up to 2 years postsurgery. There were no significant differences in adjusted costs in the first 9 months postsurgery, but kyphoplasty patients were associated with significantly lower adjusted treatment costs by 6.8–7.9 % in the remaining periods through 2 years postsurgery.
Vertebral augmentation has been shown to be safe and effective for treating vertebral compression fractures. Comparative cost studies of initial treatment costs for kypho- and vertebroplasty have been mixed. The purpose of our study was to compare the costs for treating kypho- and vertebroplasty patients at up to 2 years postsurgery.
Vertebroplasty and kyphoplasty patients diagnosed with pathologic or closed lumbar/thoracic vertebral fractures were identified from the 5 % sample of the Medicare dataset (2006–2009). The final study cohort with at least 2 years follow-up comprised of 1,609 vertebroplasty and 2,878 kyphoplasty patients. The cumulative treatment costs (adjusted to June 2011 US$) were determined from the payer perspective. Differences in costs and length of stay were assessed by generalized linear mixed model regression, adjusting for covariates.
The average adjusted costs for vertebroplasty patients within the first quarter and the first 2 years postsurgery were $14,585 [95 % confidence interval (CI), $14,109–15,078] and $44,496 (95 % CI, $42,763–46,299), respectively. The corresponding average adjusted costs for kyphoplasty patients were $15,117 (95 % CI, $14,752–15,491) and $41,339 (95 % CI, $40,154–42,560). There were no significant differences in adjusted costs in the first 9 months postsurgery, but kyphoplasty patients were associated with significantly lower adjusted treatment costs by 6.8–7.9 % in the remaining periods through 2 years postsurgery.
Our present study addresses some of the limitations in previous comparative cost studies of vertebroplasty and kyphoplasty. The higher adjusted costs for vertebroplasty patients than kyphoplasty patients by 1 year following the surgery reflect greater utilization of medical resources.
- Cooper C (2010) Osteoporosis: disease severity and consequent fracture management. Osteoporos Int 21(Suppl 2):S425–S429 CrossRef
- Lau E, Ong K, Kurtz S, Schmier J, Edidin A (2008) Mortality following the diagnosis of a vertebral compression fracture in the medicare population. J Bone Jt Surg Am 90:1479–1486 CrossRef
- Phillips FM (2003) Minimally invasive treatments of osteoporotic vertebral compression fractures. Spine 28:S45–S53
- Diel P, Reuss W, Aghayev E, Moulin P, Roder C (2010) SWISSspine—a nationwide health technology assessment registry for balloon kyphoplasty: methodology and first results. Spine J 10:961–971 CrossRef
- Felder-Puig R, Piso B, Guba B, Gartlehner G (2009) Kyphoplasty and vertebroplasty for the management of osteoporotic vertebral compression fractures: a systematic review. Orthopade 38:606–615 CrossRef
- Jensen ME, McGraw JK, Cardella JF, Hirsch JA (2007) Position statement on percutaneous vertebral augmentation: a consensus statement developed by the American Society of Interventional and Therapeutic Neuroradiology, Society of Interventional Radiology, American Association of Neurological Surgeons/Congress of Neurological Surgeons, and American Society of Spine Radiology. AJNR Am J Neuroradiol 28:1439–1443
- Buchbinder R, Osborne RH, Ebeling PR, Wark JD, Mitchell P, Wriedt C, Graves S, Staples MP, Murphy B (2009) A randomized trial of vertebroplasty for painful osteoporotic vertebral fractures. N Engl J Med 361:557–568 CrossRef
- Kallmes DF, Comstock BA, Heagerty PJ, Turner JA, Wilson DJ, Diamond TH, Edwards R, Gray LA, Stout L, Owen S, Hollingworth W, Ghdoke B, Annesley-Williams DJ, Ralston SH, Jarvik JG (2009) A randomized trial of vertebroplasty for osteoporotic spinal fractures. N Engl J Med 361:569–579 CrossRef
- Klazen CA, Lohle PN, de Vries J, Jansen FH, Tielbeek AV, Blonk MC, Venmans A, van Rooij WJ, Schoemaker MC, Juttmann JR, Lo TH, Verhaar HJ, van der Graaf Y, van Everdingen KJ, Muller AF, Elgersma OE, Halkema DR, Fransen H, Janssens X, Buskens E, Mali WP (2010) Vertebroplasty versus conservative treatment in acute osteoporotic vertebral compression fractures (Vertos II): an open-label randomised trial. Lancet 376:1085–1092 CrossRef
- Boonen S, Van Meirhaeghe J, Bastian L, Cummings SR, Ranstam J, Tillman JB, Eastell R, Talmadge K, Wardlaw D (2011) Balloon kyphoplasty for the treatment of acute vertebral compression fractures: 2-year results from a randomized trial. J Bone Miner Res 26:1627–1637 CrossRef
- Wardlaw D, Cummings SR, Van Meirhaeghe J, Bastian L, Tillman JB, Ranstam J, Eastell R, Shabe P, Talmadge K, Boonen S (2009) Efficacy and safety of balloon kyphoplasty compared with non-surgical care for vertebral compression fracture (FREE): a randomised controlled trial. Lancet 373:1016–1024 CrossRef
- Fritzell P, Ohlin A, Borgstrom F (2011) Cost-effectiveness of balloon kyphoplasty (BKP) vs. standard medical treatment in patients with osteoporotic vertebral compression fracture—a Swedish multicenter RCT with two year FU. Spine 36:2243–2251
- Strom O, Leonard C, Marsh D, Cooper C (2010) Cost-effectiveness of balloon kyphoplasty in patients with symptomatic vertebral compression fractures in a UK setting. Osteoporos Int 21:1599–1608 CrossRef
- Mehio AK, Lerner JH, Engelhart LM, Kozma CM, Slaton TL, Edwards NC, Lawler GJ (2011) Comparative hospital economics and patient presentation: vertebroplasty and kyphoplasty for the treatment of vertebral compression fracture. AJNR Am J Neuroradiol 32:1290–1294 CrossRef
- Lad SP, Patil CG, Lad EM, Hayden MG, Boakye M (2009) National trends in vertebral augmentation procedures for the treatment of vertebral compression fractures. Surg Neurol 71:580–584, discussion 584-585 CrossRef
- Ofluoglu O (2009) Minimally invasive management of spinal metastases. Orthop Clin North Am 40:155–168, viii CrossRef
- Zou J, Mei X, Gan M, Yang H (2010) Kyphoplasty for spinal fractures from multiple myeloma. J Surg Oncol 102:43–47 CrossRef
- Lee B, Franklin I, Lewis JS, Coombes RC, Leonard R, Gishen P, Stebbing J (2009) The efficacy of percutaneous vertebroplasty for vertebral metastases associated with solid malignancies. Eur J Cancer 45:1597–1602 CrossRef
- Bureau of Labor Statistics (2011) Consumer Price Index. In.
- Deyo RA, Cherkin DC, Ciol MA (1992) Adapting a clinical comorbidity index for use with ICD-9-CM administrative databases. J Clin Epidemiol 45:613–619 CrossRef
- Kilian R, Matschinger H, Loeffler W, Roick C, Angermeyer MC (2002) A comparison of methods to handle skew distributed cost variables in the analysis of the resource consumption in schizophrenia treatment. J Ment Health Policy Econ 5:21–31
- Zampini JM, White AP, McGuire KJ (2010) Comparison of 5766 vertebral compression fractures treated with or without kyphoplasty. Clin Orthop Relat Res 468:1773–1780 CrossRef
- Masala S, Ciarrapico AM, Konda D, Vinicola V, Mammucari M, Simonetti G (2008) Cost-effectiveness of percutaneous vertebroplasty in osteoporotic vertebral fractures. Eur Spine J 17:1242–1250 CrossRef
- Lee MJ, Dumonski M, Cahill P, Stanley T, Park D, Singh K (2009) Percutaneous treatment of vertebral compression fractures: a meta-analysis of complications. Spine 34:1228–1232 CrossRef
- Kumar K, Nguyen R, Bishop S (2010) A comparative analysis of the results of vertebroplasty and kyphoplasty in osteoporotic vertebral compression fractures. Neurosurgery 67:171–188, discussion ons188 CrossRef
- Han S, Wan S, Ning L, Tong Y, Zhang J, Fan S (2011) Percutaneous vertebroplasty versus balloon kyphoplasty for treatment of osteoporotic vertebral compression fracture: a meta-analysis of randomised and non-randomised controlled trials. Int Orthop 35:1349–1358 CrossRef
- Liu JT, Liao WJ, Tan WC, Lee JK, Liu CH, Chen YH, Lin TB (2010) Balloon kyphoplasty versus vertebroplasty for treatment of osteoporotic vertebral compression fracture: a prospective, comparative, and randomized clinical study. Osteoporos Int 21:359–364 CrossRef
- Frankel BM, Monroe T, Wang C (2007) Percutaneous vertebral augmentation: an elevation in adjacent-level fracture risk in kyphoplasty as compared with vertebroplasty. Spine J 7:575–582 CrossRef
- Barrett J, Losina E, Baron JA, Mahomed NN, Wright J, Katz JN (2005) Survival following total hip replacement. J Bone Jt Surg Am 87:1965–1971 CrossRef
- Elshaug AG, Garber AM (2011) How CER could pay for itself—insights from vertebral fracture treatments. N Engl J Med 364:1390–1393 CrossRef
- Two-year cost comparison of vertebroplasty and kyphoplasty for the treatment of vertebral compression fractures: are initial surgical costs misleading?
Volume 24, Issue 4 , pp 1437-1445
- Cover Date
- Print ISSN
- Online ISSN
- Additional Links
- Spine fracture
- Industry Sectors
- Author Affiliations
- 1. Exponent, Inc., 3401 Market St, Suite 300, Philadelphia, PA, 19104, USA
- 2. Exponent, Inc., 149 Commonwealth Drive, Menlo Park, CA, 94025, USA
- 3. Medtronic Spinal and Biologics, 2600 Sofamor Danek Dr, Memphis, TN, 38132, USA