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Cost-Effectiveness Analysis of Treatments for Vertebral Compression Fractures

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Abstract

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.

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Acknowledgements

This study was supported by a research grant from Medtronic, Inc. Medtronic (AAE, JEK) contributed to the study design, data monitoring and reporting of the results, as well as with the preparation of the manuscript, but did not play a role in the collection or statistical analysis of the data. The authors have no other conflicts of interest that are directly relevant to the content of this study.

Each author’s contributions are as follows: study design (AAE, JEK, KLO, EL, JKS, SMK), data monitoring (KLO, EL, AAE, JEK), statistical analysis (EL), cost-effectiveness modelling (JKS), reporting of the results (AAE, JEK, KLO, EL, JKS, SMK) and preparation of the manuscript (AAE, JEK, KLO, JKS, SMK). KO will act as the guarantor for the overall content.

IRB approval: N/A; this study utilized a publicly-available administrative database.

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Authors and Affiliations

  1. Medtronic Spinal and Biologics, Sunnyvale, California, USA

    Avram A. Edidin

  2. Exponent, Inc., 3401 Market St, Suite 300, Philadelphia, Pennsylvania, 19104, USA

    Kevin L. Ong Ph.D. & Steven M. Kurtz

  3. Exponent, Inc., Menlo Park, California, USA

    Edmund Lau

  4. Exponent, Inc., Alexandria, Virginia, USA

    Jordana Schmier

  5. Medtronic Spinal and Biologics, Memphis, Tennessee, USA

    Jason E. Kemner

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  1. Avram A. Edidin
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  2. Kevin L. Ong Ph.D.
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  3. Edmund Lau
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  6. Steven M. Kurtz
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Correspondence to Kevin L. Ong Ph.D..

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Edidin, A.A., Ong, K.L., Lau, E. et al. Cost-Effectiveness Analysis of Treatments for Vertebral Compression Fractures. Appl Health Econ Health Policy 10, 273–284 (2012). https://doi.org/10.2165/11633220-000000000-00000

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