Applied Health Economics and Health Policy

, Volume 10, Issue 4, pp 273–284

Cost-Effectiveness Analysis of Treatments for Vertebral Compression Fractures

  • Avram A. Edidin
  • Kevin L. Ong
  • Edmund Lau
  • Jordana Schmier
  • Jason E. Kemner
  • Steven M. Kurtz
Original Research Article


Background: Vertebral compression fractures (VCFs) can be treated by nonsurgical management or by minimally invasive surgical treatment including vertebroplasty and balloon kyphoplasty.

Objective: The purpose of the present study was to characterize the cost to Medicare for treating VCF-diagnosed patients by nonsurgical management, vertebroplasty, or kyphoplasty. We hypothesized that surgical treatments for VCFs using vertebroplasty or kyphoplasty would be a cost-effective alternative to nonsurgical management for the Medicare patient population.

Methods: Cost per life-year gained for VCF patients in the US Medicare population was compared between operated (kyphoplasty and vertebroplasty) and non-operated patients and between kyphoplasty and vertebroplasty patients, all as a function of patient age and gender. Life expectancy was estimated using a parametric Weibull survival model (adjusted for comorbidities) for 858 978 VCF patients in the 100% Medicare dataset (2005–2008). Median payer costs were identified for each treatment group for up to 3 years following VCF diagnosis, based on 67018 VCF patients in the 5% Medicare dataset (2005–2008). A discount rate of 3% was used for the base case in the cost-effectiveness analysis, with 0% and 5% discount rates used in sensitivity analyses.

Results: After accounting for the differences in median costs and using a discount rate of 3%, the cost per life-year gained for kyphoplasty and ver-tebroplasty patients ranged from $US1863 to $US6687 and from $US2452 to $US13 543, respectively, compared with non-operated patients. The cost per life-year gained for kyphoplasty compared with vertebroplasty ranged from -$US4878 (cost saving) to $US2763.

Conclusions: Among patients for whom surgical treatment was indicated, kyphoplasty was found to be cost effective, and perhaps even cost saving, compared with vertebroplasty. Even for the oldest patients (85 years of age and older), both interventions would be considered cost effective in terms of cost per life-year gained.


  1. 1.
    Cooper C. Osteoporosis: disease severity and consequent fracture management. Osteoporos Int 2010 Jun; 21Suppl. 2: S425–9PubMedCrossRefGoogle Scholar
  2. 2.
    Lau E, Ong Kurtz S, et al. Mortality following the diagnosis of a vertebral compression fracture in the Medicare population. J Bone Joint Surg 2008 Jul; 90(7): 1479–86PubMedCrossRefGoogle Scholar
  3. 3.
    Elshaug AG, Garber AM. How CER could pay for itself: insights from vertebral fracture treatments. N Engl J Med 2011 Apr 14; 364(15): 1390–3PubMedCrossRefGoogle Scholar
  4. 4.
    Strom Leonard Marsh D, et al. Cost-effectiveness of balloon kyphoplasty in patients with symptomatic vertebral compression fractures in a UK setting. Osteoporos Int 2010 Sep; 21(9): 1599–608PubMedCrossRefGoogle Scholar
  5. 5.
    Edidin AA, Ong KL, Lau E, et al. Mortality risk for operated and nonoperated vertebral fracture patients in the Medicare population. J Bone Miner Res 2011 Jul; 26(7): 1617–26PubMedCrossRefGoogle Scholar
  6. 6.
    Deyo RA, Cherkin DC, Ciol MA. Adapting a clinical comorbidity index for use with ICD-9-CM administrative databases. J Clin Epidemiol 1992 Jun; 45(6): 613–9PubMedCrossRefGoogle Scholar
  7. 7.
    Kado DM, Browner WS, Palermo L, et al. Vertebral fractures and mortality in older women: a prospective study. Study of Osteoporotic Fractures Research Group. Arch Intern Med 1999 Jun 14; 159(11): 1215–20PubMedCrossRefGoogle Scholar
  8. 8.
    Gaitatzis A, Johnson AL, Chadwick DW, et al. Life expectancy in people with newly diagnosed epilepsy. Brain 2004 Nov; 127 (Pt 11): 2427–32PubMedCrossRefGoogle Scholar
  9. 9.
    Puvimanasinghe JP, Takkenberg JJ, Eijkemans MJ, et al. Prognosis after aortic valve replacement with the Carpen-tier-Edwards pericardial valve: use of microsimulation. Ann Thorac Surg 2005 Sep; 80(3): 825–31PubMedCrossRefGoogle Scholar
  10. 10.
    Bureau of Labor Statistics. Consumer Price Index, 2010 [online]. Available from URL: [Accessed 2010 Dec 27]
  11. 11.
    Lipscomb J, Weinstein MC, Torrance GW. Time preference. In: Gold MR, Seigel JE, Russel LB, et al., editors. Cost-effectiveness in health and medicine. New York, NY: Oxford University Press, 1996Google Scholar
  12. 12.
    Buchbinder R, Osborne RH, Ebeling PR, et al. A randomized trial of vertebroplasty for painful osteoporotic vertebral fractures. N Engl J Med 2009 Aug 6; 361(6): 557–68PubMedCrossRefGoogle Scholar
  13. 13.
    Kallmes DF, Comstock BA, Heagerty PJ, et al. A randomized trial of vertebroplasty for osteoporotic spinal fractures. N Engl J Med 2009 Aug 6; 361(6): 569–79PubMedCrossRefGoogle Scholar
  14. 14.
    Braithwaite RS, Meltzer DO, King Jr JT, et al. What does the value of modern medicine say about the $50,000 per quality-adjusted life-year decision rule? Med Care 2008 Apr; 46(4): 349–56PubMedCrossRefGoogle Scholar
  15. 15.
    Owens DK. Interpretation of cost-effectiveness analyses. J Gen Intern Med 1998 Oct; 13(10): 716–7PubMedCrossRefGoogle Scholar
  16. 16.
    Owens DK, Qaseem A, Chou R, et al. High-value, cost-conscious health care: concepts for clinicians to evaluate the benefits, harms, and costs of medical interventions. Ann Intern Med 2011 Feb 1; 154(3): 174–80PubMedGoogle Scholar
  17. 17.
    Li R, Zhang P, Barker LE, et al. Cost-effectiveness of interventions to prevent and control diabetes mellitus: a systematic review. Diabetes Care 2010 Aug; 33(8): 1872–94PubMedCrossRefGoogle Scholar
  18. 18.
    Klazen CA, Lohle PN, de Vries J, et al. Vertebroplasty versus conservative treatment in acute osteoporotic vertebral compression fractures (Vertos II): an open-label randomised trial. Lancet 2010 Sep 25; 376(9746): 1085–92PubMedCrossRefGoogle Scholar
  19. 19.
    Wardlaw D, Cummings SR, Van Meirhaeghe J, et al. Efficacy and safety of balloon kyphoplasty compared with non-surgical care for vertebral compression fracture (FREE): a randomised controlled trial. Lancet 2009 Mar 21; 373(9668): 1016–24PubMedCrossRefGoogle Scholar
  20. 20.
    Boonen S, Van Meirhaeghe J, Bastian L, et al. Balloon kyphoplasty for the treatment of acute vertebral compression fractures: 2-year results from a randomized trial. J Bone Miner Res 2011 Jul; 26(7): 1627–37PubMedCrossRefGoogle Scholar
  21. 21.
    Fritzell P, Ohlin A, Borgstrom F. Cost-effectiveness of balloon kyphoplasty versus standard medical treatment in patients with osteoporotic vertebral compression fracture: a Swedish multicenter randomized controlled trial with 2-year follow-up. Spine (Phila Pa 19762011; 36(26): 2243–51CrossRefGoogle Scholar
  22. 22.
    Yang HL, Zhao L, Liu J, et al. Changes of pulmonary function for patients with osteoporotic vertebral compression fractures after kyphoplasty. J Spinal Disord Tech 2007 May; 20(3): 221–5PubMedCrossRefGoogle Scholar
  23. 23.
    Hasserius R, Karlsson MK, Nilsson BE, et al. Prevalent vertebral deformities predict increased mortality and increased fracture rate in both men and women: a 10-year population-based study of 598 individuals from the Swedish cohort in the European Vertebral Osteoporosis Study. Osteoporos Int 2003 Jan; 14(1): 61–8PubMedCrossRefGoogle Scholar
  24. 24.
    Leech JA, Dulberg C, Kellie S, et al. Relationship of lung function to severity of osteoporosis in women. Am Rev Respir Dis 1990 Jan; 141(1): 68–71PubMedCrossRefGoogle Scholar
  25. 25.
    Pradhan BB, Bae HW, Kropf MA, et al. Kyphoplasty reduction of osteoporotic vertebral compression fractures: correction of local kyphosis versus overall sagittal alignment. Spine 2006 Feb 15; 31(4): 435–41PubMedCrossRefGoogle Scholar
  26. 26.
    Maestretti G, Cremer C, Otten P, et al. Prospective study of stand-alone balloon kyphoplasty with calcium phosphate cement augmentation in traumatic fractures. Eur Spine J 2007 May; 16(5): 601–10PubMedCrossRefGoogle Scholar
  27. 27.
    Alvarez L, Alcaraz M, Perez-Higueras A, et al. Percutaneous vertebroplasty: functional improvement in patients with osteoporotic compression fractures. Spine 2006 May 1; 31(10): 1113–8PubMedCrossRefGoogle Scholar
  28. 28.
    Garfin SR, Yuan HA, Reiley MA. New technologies in spine: kyphoplasty and vertebroplasty for the treatment of painful osteoporotic compression fractures. Spine 2001 Jul 15; 26(14): 1511–5PubMedCrossRefGoogle Scholar
  29. 29.
    Grados F, Depriester Cayrolle G, et al. Long-term observations of vertebral osteoporotic fractures treated by percutaneous vertebroplasty. Rheumatology (Oxford) 2000 Dec; 39(12): 1410–4CrossRefGoogle Scholar
  30. 30.
    Lieberman IH, Dudeney S, Reinhardt MK, et al. Initial outcome and efficacy of “kyphoplasty” in the treatment of painful osteoporotic vertebral compression fractures. Spine 2001 Jul 15; 26(14): 1631–8PubMedCrossRefGoogle Scholar
  31. 31.
    Zoarski GH, Snow P, Olan WJ, et al. Percutaneous vertebroplasty for osteoporotic compression fractures: quantitative prospective evaluation of long-term outcomes. J Vasc Interv Radiol 2002 Feb; 13 (2 Pt 1): 139–48PubMedCrossRefGoogle Scholar
  32. 32.
    De Negri P, Tirri T, Paternoster G, et al. Treatment of painful osteoporotic or traumatic vertebral compression fractures by percutaneous vertebral augmentation procedures: a nonrandomized comparison between vertebroplasty and kyphoplasty. Clin J Pain 2007 Jun; 23(5): 425–30PubMedCrossRefGoogle Scholar
  33. 33.
    Cooper Atkinson EJ, Jacobsen SJ, et al. Population-based study of survival after osteoporotic fractures. Am J Epidemiol 1993 May 1; 137(9): 1001–5PubMedGoogle Scholar
  34. 34.
    Bliuc D, Nguyen ND, Milch VE, et al. Mortality risk associated with low-trauma osteoporotic fracture and subsequent fracture in men and women. JAMA 2009 Feb 4; 301(5): 513–21PubMedCrossRefGoogle Scholar
  35. 35.
    Johnell O, Kanis JA, Oden A, et al. Mortality after osteoporotic fractures. Osteoporos Int 2004 Jan; 15(1): 38–42PubMedCrossRefGoogle Scholar

Copyright information

© Springer International Publishing AG 2012

Authors and Affiliations

  • Avram A. Edidin
    • 1
  • Kevin L. Ong
    • 2
  • Edmund Lau
    • 3
  • Jordana Schmier
    • 4
  • Jason E. Kemner
    • 5
  • Steven M. Kurtz
    • 2
  1. 1.Medtronic Spinal and BiologicsSunnyvaleUSA
  2. 2.Exponent, Inc.PhiladelphiaUSA
  3. 3.Exponent, Inc.Menlo ParkUSA
  4. 4.Exponent, Inc.AlexandriaUSA
  5. 5.Medtronic Spinal and BiologicsMemphisUSA

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