128 - Comparison of Vertebroplasty, Kyphoplasty and Nonsurgical Management o...

#128 Comparison of Vertebroplasty, Kyphoplasty and Nonsurgical Management of Vertebral Compression Fractures (VCF) and Impact on U.S. Healthcare Resource Utilization

General Session: Best Papers Session 2

Presented by: M. Hazzard

Author(s):

M.A. Hazzard (1)
S.P. Lad (1)
R. Babu (1)
R.E. Isaacs (1)
B. Ugiliweneza (2)
M. Boakye (2)
C.G. Patil (3)

(1) Duke University, Division of Neurosurgery, Durham, NC, USA
(2) University of Louisville, Department of Neurosurgery, Louisville, KY, USA
(3) Cedars Sinai Medical Center, Department of Neurosurgery, West Hollywood, CA, USA

Abstract

Background and Purpose: Options for the treatment of vertebral compression fractures (VCFs) include conservative (nonsurgical) management, as well as 2 minimally invasive spine augmentation procedures, kyphoplasty and vertebroplasty. The cost-effectiveness of these currently available surgical interventions for VCF has been criticized and some suggest outcomes similar to placebo. The goal of the present study was to examine the Thomson Reuters MarketScan® database, comparing the outcomes of VCF treatment options with an emphasis on re-operation, complications, cost and overall healthcare resource use between 2005 and 2009 in the United States.

Materials and Methods: Patients 18 years of age and older were identified from the MarketScan® database using primary diagnosis codes (ICD-9-pathologic vertebral fracture, 733.13; closed fracture of thoracic vertebra, 805.2; closed fracture of lumbar vertebra, 805.4) and both relevant ICD-9 and CPT-4 procedure codes. After identifying patients diagnosed and treated for VCF between 2005 and 2009, propensity score (PS) matching was performed to attain a demographically similar sample. Pre-operative and post-operative follow-up times were calculated from index hospitalization. Main outcomes assessed included re-operation, complications, healthcare resource use and associated cost. The compiled data tables were then statistically analyzed and reported at 3 separate intervals (index hospitalization, 2-year follow-up, and 4-year follow-up).

Results: From 2005 to 2009, 20,740 patients with VCFs were recorded in the MarketScan® database, yielding 7,290 after PS matching. The mean age of our study sample across the 3 intervals was between 75 and 78 years and 74-79% were female. The majority had a Charlson comorbidity index of 0 or 1. Re-operation rates ranged from 6-17% while complication rates ranged from 7-10%. Although overall costs were noted to be significantly greater in both the kyphoplasty and vertebroplasty groups at 1 year, this difference did not remain in the 2- and 4-year follow-up analysis. Overall, regardless of option selected, the cost of treating a VCF patient at 4 years follow-up was approximately $100,000 U.S. dollars (USD).

Conclusions: Our findings suggest, regardless of option selected, treatment of a VCF patient will likely be associated with similar long-term operative and complication rates and will uniformly cost ~$100,000 USD over 4 years. Given similar healthcare resource use and costs as well as re-operation and complication rates, the impact of the therapy on long-term pain relief, disability improvement and quality-of-life outcomes data seems to be of primary importance in helping patients and providers decide upon best treatment for VCFs. Recent evidence demonstrating improved functional outcomes with vertebral augmentation over conservative therapy may support wider use of these procedures for the treatment of painful VCFs.

Results Table

Complication rates for all PS matched patients