title: Cost-effectiveness analysis of treatments for vertebral compression fractures.
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 67 018 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 vertebroplasty 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.
authors.affiliation: Medtronic Spinal and Biologics, Sunnyvale, CA, USA.
authors.forename: Avram A
authors.initials: AA
authors.lastname: Edidin
authors.forename: Kevin L
authors.initials: KL
authors.lastname: Ong
authors.forename: Edmund
authors.initials: E
authors.lastname: Lau
authors.forename: Jordana K
authors.initials: JK
authors.lastname: Schmier
authors.forename: Jason E
authors.initials: JE
authors.lastname: Kemner
authors.forename: Steven M
authors.initials: SM
authors.lastname: Kurtz
mesh_terms: D000368:Aged; D003362:Cost-Benefit Analysis; D005260:Female; D050815:Fractures, Compression / Q000191:economics* / Q000601:surgery / Q000628:therapy; D006801:Humans; D058498:Kyphoplasty / Q000191:economics; D008297:Male; D006278:Medicare / Q000191:economics*; D019057:Quality-Adjusted Life Years; D016103:Spinal Fractures / Q000191:economics* / Q000601:surgery / Q000628:therapy; D014481:United States; D054854:Vertebroplasty / Q000191:economics*