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Health economic aspects of vertebral augmentation procedures

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Abstract

We reviewed all peer-reviewed papers analysing the cost-effectiveness of vertebroplasty and balloon kyphoplasty for osteoporotic vertebral compression fractures. In general, the procedures appear to be cost effective but are very dependent upon model input details. Better data, rather than new models, are needed to answer outstanding questions. Vertebral augmentation procedures (VAPs), including vertebroplasty (VP) and balloon kyphoplasty (BKP), seek to stabilise fractured vertebral bodies and reduce pain. The aim of this paper is to review current literature on the cost-effectiveness of VAPs as well as to discuss the challenges for economic evaluation in this research area. A systematic literature search was conducted to identify existing published studies on the cost-effectiveness of VAPs in patients with osteoporosis. Only peer-reviewed published articles that fulfilled the criteria of being regarded as full economic evaluations including both morbidity and mortality in the outcome measure in the form of quality-adjusted life years (QALYs) were included. The search identified 949 studies, of which four (0.4 %) were identified as relevant with one study added later. The reviewed studies differed widely in terms of study design, modelling framework and data used, yielding different results and conclusions regarding the cost-effectiveness of VAPs. Three out of five studies indicated in the base case results that VAPs were cost effective compared to non-surgical management (NSM). The five main factors that drove the variations in the cost-effectiveness between the studies were time horizon, quality of life effect of treatment, offset time of the treatment effect, reduced number of bed days associated with VAPs and mortality benefit with treatment. The cost-effectiveness of VAPs is uncertain. In answering the remaining questions, new cost-effectiveness analysis will yield limited benefit. Rather, studies that can reduce the uncertainty in the underlying data, especially regarding the long-term clinical outcomes of VAPs, should be conducted.

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Conflicts of interest

Quantify Research, where FB is a partner and GO an employee, received funding from Medtronic Inc. Medtronic did not comment on the contents of this paper. AJS has been consultant to and number of advisory boards for Amgen, Actavis, Eli Lilly, Medtronic and Mission Pharmacal and received speaker’s bureau honoraria from Amgen and Mission Pharmacal. DPB, SB, SB, SC, DFK, JAK and KÅ declare that they do not have any conflict of interest.

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Authors and Affiliations

  1. Quantify Research, Stockholm, Sweden

    F. Borgström & G. Olafsson

  2. Department of Learning, Informatics, Management and Ethics, Karolinska Institutet, Stockholm, Sweden

    F. Borgström & G. Olafsson

  3. Clinical Radiology of Oklahoma, Oklahoma Spine Hospital, Oklahoma, OK, USA

    D. P. Beall

  4. Department of Orthopaedic Surgery, University of California San Francisco Medical Center, San Francisco, CA, USA

    S. Berven

  5. Division of Gerontology and Geriatrics, Leuven University, Leuven, Belgium

    S. Boonen

  6. Division of Neurosurgery, Dalhousie University, Halifax, Nova Scotia, Canada

    S. Christie

  7. Department of Radiology, Mayo Clinic, Rochester, MN, USA

    D. F. Kallmes

  8. Department of Neurosurgery, Mayo Clinic, Rochester, MN, USA

    D. F. Kallmes

  9. Centre for Metabolic Bone Diseases, Medical School, University of Sheffield, Sheffield, UK

    J. A. Kanis

  10. Department of Obstetrics and Gynecology, MedStar Georgetown University Hospital, Washington DC, USA

    A. J. Singer

  11. Department of Orthopaedics, Skåne University Hospital, Malmö, Sweden

    K. Åkesson

  12. Department of Medicine, MedStar Georgetown University Hospital, Washington DC, USA

    A. J. Singer

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  1. F. Borgström
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  2. D. P. Beall
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  3. S. Berven
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  4. S. Boonen
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  5. S. Christie
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  6. D. F. Kallmes
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  7. J. A. Kanis
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  8. G. Olafsson
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  9. A. J. Singer
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  10. K. Åkesson
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Corresponding author

Correspondence to F. Borgström.

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S. Boonen is deceased.

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Borgström, F., Beall, D.P., Berven, S. et al. Health economic aspects of vertebral augmentation procedures. Osteoporos Int 26, 1239–1249 (2015). https://doi.org/10.1007/s00198-014-2953-5

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