Two-year cost comparison of vertebroplasty and kyphoplasty for the treatment of vertebral compression fractures: Are initial surgical costs misleading?

Abstract

Summary: The costs for treating kypho- and vertebroplasty patients were evaluated at up to 2 years postsurgery. There were no significant differences in adjusted costs in the first 9 months postsurgery, but kyphoplasty patients were associated with significantly lower adjusted treatment costs by 6.8-7.9 % in the remaining periods through 2 years postsurgery. Introduction: Vertebral augmentation has been shown to be safe and effective for treating vertebral compression fractures. Comparative cost studies of initial treatment costs for kypho- and vertebroplasty have been mixed. The purpose of our study was to compare the costs for treating kypho- and vertebroplasty patients at up to 2 years postsurgery. Methods: Vertebroplasty and kyphoplasty patients diagnosed with pathologic or closed lumbar/thoracic vertebral fractures were identified from the 5 % sample of the Medicare dataset (2006-2009). The final study cohort with at least 2 years follow-up comprised of 1,609 vertebroplasty and 2,878 kyphoplasty patients. The cumulative treatment costs (adjusted to June 2011 US$) were determined from the payer perspective. Differences in costs and length of stay were assessed by generalized linear mixed model regression, adjusting for covariates. Results: The average adjusted costs for vertebroplasty patients within the first quarter and the first 2 years postsurgery were $14,585 [95 % confidence interval (CI), $14,109-15,078] and $44,496 (95 % CI, $42,763-46,299), respectively. The corresponding average adjusted costs for kyphoplasty patients were $15,117 (95 % CI, $14,752-15,491) and $41,339 (95 % CI, $40,154-42,560). There were no significant differences in adjusted costs in the first 9 months postsurgery, but kyphoplasty patients were associated with significantly lower adjusted treatment costs by 6.8-7.9 % in the remaining periods through 2 years postsurgery. Conclusion: Our present study addresses some of the limitations in previous comparative cost studies of vertebroplasty and kyphoplasty. The higher adjusted costs for vertebroplasty patients than kyphoplasty patients by 1 year following the surgery reflect greater utilization of medical resources. © 2012 International Osteoporosis Foundation and National Osteoporosis Foundation.