Balloon kyphoplasty compared to vertebroplasty and nonsurgical management in patients hospitalised with acute osteoporotic vertebral compression fracture: a UK cost-effectiveness analysis.
The purpose of the study was to estimate the cost-effectiveness of balloon kyphoplasty compared to nonsurgical management and vertebroplasty for the treatment of hospitalised osteoporotic vertebral compression fractures in the UK. A cost-effectiveness model was constructed and used for analysis. Balloon kyphoplasty may be cost-effective compared to relevant alternatives.


BACKGROUND
The objective of this study was to estimate the cost-effectiveness of balloon kyphoplasty (BKP) for the treatment of patients hospitalised with acute osteoporotic vertebral compression fracture (OVCF) compared to percutaneous vertebroplasty (PVP) and nonsurgical management (NSM) in the UK.


METHODS
A Markov simulation model was developed to evaluate treatment with BKP, NSM and PVP in patients with symptomatic OVCF. Data on health-related quality of life (HRQoL) with acute OVCF were derived from the FREE and VERTOS II randomised clinical trials (RCTs) and normalised to the NSM arm in the FREE trial. Estimated differences in mortality among the treatments and costs for NSM were obtained from the literature whereas procedure costs for BKP and PVP were obtained from three National Health Service hospitals. It was assumed that BKP and PVP reduced hospital length of stay by 6 days compared to NSM.


RESULTS
The incremental cost-effectiveness ratio was estimated at Great Britain Pound Sterling (GBP) 2,706 per quality-adjusted life year (QALY) and GBP 15,982 per QALY compared to NSM and PVP, respectively. Sensitivity analysis showed that the cost-effectiveness of BKP vs. NSM was robust when mortality and HRQoL benefits with BKP were varied. The cost-effectiveness of BKP compared to PVP was particularly sensitive to changes in the mortality benefit.


CONCLUSIONS
BKP may be a cost-effective strategy for the treatment of patients hospitalised with acute OVCF in the UK compared to NSM and PVP. Additional RCT data on the benefits of BKP and PVP compared to simulated sham surgery and further data on the mortality benefits with BKP compared to NSM and PVP would reduce uncertainty.
OptumInsight, Klarabergsviadukten 90, Hus D, 111 64, Stockholm, Sweden. axel.svedbom@optum.com
A
A
Svedbom
L
L
Alvares
C
C
Cooper
D
D
Marsh
O
O
Ström
D003362:Cost-Benefit Analysis; D050815:Fractures, Compression / Q000191:economics / Q000453:epidemiology / Q000601:surgery* / Q000628:therapy; D017048:Health Care Costs / Q000706:statistics & numerical data; D006760:Hospitalization / Q000706:statistics & numerical data; D006801:Humans; D015994:Incidence; D058498:Kyphoplasty / Q000191:economics* / Q000379:methods; D017059:Models, Econometric; D058866:Osteoporotic Fractures / Q000191:economics / Q000453:epidemiology / Q000601:surgery* / Q000628:therapy; D016103:Spinal Fractures / Q000191:economics / Q000453:epidemiology / Q000601:surgery* / Q000628:therapy; D006113:United Kingdom / Q000453:epidemiology; D054854:Vertebroplasty / Q000191:economics