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Cost-Effectiveness of Balloon Kyphoplasty Versus Standard Medical Treatment in Patients With Osteoporotic Vertebral Compression Fracture

Fritzell, Peter; Ohlin, Acke LU and Borgstrom, Fredrik (2011) In Spine 36(26). p.2243-2251
Abstract
Study Design. A multicenter, randomized, controlled, cost-effectiveness analysis. Objective. To assess the cost-effectiveness of balloon kyphoplasty (BKP) compared with standard medical treatment (control) in patients with acute/subacute (<3 months) vertebral compression fracture (VCF) due to osteoporosis. Summary of Background Data. Patients with a VCF due to osteoporosis are common and will increase in number in an aging population, putting a substantial strain on health care. Selected patients may benefit from stabilizing the fracture with cement through BKP, a minimally invasive procedure. BKP has been reported to give good short-time clinical results, and economic modeling has suggested that the procedure could be cost-effective... (More)
Study Design. A multicenter, randomized, controlled, cost-effectiveness analysis. Objective. To assess the cost-effectiveness of balloon kyphoplasty (BKP) compared with standard medical treatment (control) in patients with acute/subacute (<3 months) vertebral compression fracture (VCF) due to osteoporosis. Summary of Background Data. Patients with a VCF due to osteoporosis are common and will increase in number in an aging population, putting a substantial strain on health care. Selected patients may benefit from stabilizing the fracture with cement through BKP, a minimally invasive procedure. BKP has been reported to give good short-time clinical results, and economic modeling has suggested that the procedure could be cost-effective after 2 years compared with standard treatment. Methods. Hospitalized patients with back pain due to VCF were randomized to BKP or to control using a computer-generated random list. All costs associated with VCF and cost-effectiveness were reported primarily from the perspective of society. We used EQ-5D to assess quality of life (QoL). The accumulated quality-adjusted life years (QALYs) gained and costs/QALY gained were assessed using intention to treat. Results. Between February 2003 and December 2005, a total of 63 out of 67 Swedish patients were analyzed: BKP (n = 32) and control (n = 31). Societal cost per patient for BKP was SEK 160,017 (SD = 151,083) = (sic)16,668 (SD = 15,735), and for control SEK 84,816 (SD = - 40,954) = (sic) 8835 (SD = 4266), a significant difference of 75,198 (95% confidence intervals [CI] = 16,037-120,104) = (sic)7833 (95% CI = 1671-12,511). The accumulated difference in QALYs was 0.085 (95% CI = -0.132 to 0.306) in favor of BKP. Cost/QALY gained using BKP was SEK 884,682 = (sic)92,154 and US (sic)134,043. Conclusion. In this randomized controlled trial, it was not possible to demonstrate that BKP was cost-effective compared with standard medical treatment in patients treated for an acute/subacute vertebral fracture due to osteoporosis. However, sensitivity analysis indicated a certain degree of uncertainty, which needs to be considered. (Less)
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author
organization
publishing date
type
Contribution to journal
publication status
published
subject
keywords
cost-effectiveness, osteoporosis, vertebral compression fracture, minimally invasive surgery, vertebroplasty, balloon kyphoplasty, procedure, spine surgery, randomized controlled trial
in
Spine
volume
36
issue
26
pages
2243 - 2251
publisher
Lippincott Williams & Wilkins
external identifiers
  • wos:000298147100022
  • pmid:21912321
  • scopus:83255192452
ISSN
0362-2436
DOI
10.1097/BRS.0b013e3182322d0f
language
English
LU publication?
yes
id
e8cffa40-2cc6-4a18-839c-9f14227cccc0 (old id 2348332)
alternative location
http://www.ncbi.nlm.nih.gov/pubmed/21912321?dopt=Abstract
date added to LUP
2012-03-01 11:19:35
date last changed
2017-11-12 03:02:36
@article{e8cffa40-2cc6-4a18-839c-9f14227cccc0,
  abstract     = {Study Design. A multicenter, randomized, controlled, cost-effectiveness analysis. Objective. To assess the cost-effectiveness of balloon kyphoplasty (BKP) compared with standard medical treatment (control) in patients with acute/subacute (&lt;3 months) vertebral compression fracture (VCF) due to osteoporosis. Summary of Background Data. Patients with a VCF due to osteoporosis are common and will increase in number in an aging population, putting a substantial strain on health care. Selected patients may benefit from stabilizing the fracture with cement through BKP, a minimally invasive procedure. BKP has been reported to give good short-time clinical results, and economic modeling has suggested that the procedure could be cost-effective after 2 years compared with standard treatment. Methods. Hospitalized patients with back pain due to VCF were randomized to BKP or to control using a computer-generated random list. All costs associated with VCF and cost-effectiveness were reported primarily from the perspective of society. We used EQ-5D to assess quality of life (QoL). The accumulated quality-adjusted life years (QALYs) gained and costs/QALY gained were assessed using intention to treat. Results. Between February 2003 and December 2005, a total of 63 out of 67 Swedish patients were analyzed: BKP (n = 32) and control (n = 31). Societal cost per patient for BKP was SEK 160,017 (SD = 151,083) = (sic)16,668 (SD = 15,735), and for control SEK 84,816 (SD = - 40,954) = (sic) 8835 (SD = 4266), a significant difference of 75,198 (95% confidence intervals [CI] = 16,037-120,104) = (sic)7833 (95% CI = 1671-12,511). The accumulated difference in QALYs was 0.085 (95% CI = -0.132 to 0.306) in favor of BKP. Cost/QALY gained using BKP was SEK 884,682 = (sic)92,154 and US (sic)134,043. Conclusion. In this randomized controlled trial, it was not possible to demonstrate that BKP was cost-effective compared with standard medical treatment in patients treated for an acute/subacute vertebral fracture due to osteoporosis. However, sensitivity analysis indicated a certain degree of uncertainty, which needs to be considered.},
  author       = {Fritzell, Peter and Ohlin, Acke and Borgstrom, Fredrik},
  issn         = {0362-2436},
  keyword      = {cost-effectiveness,osteoporosis,vertebral compression fracture,minimally invasive surgery,vertebroplasty,balloon kyphoplasty,procedure,spine surgery,randomized controlled trial},
  language     = {eng},
  number       = {26},
  pages        = {2243--2251},
  publisher    = {Lippincott Williams & Wilkins},
  series       = {Spine},
  title        = {Cost-Effectiveness of Balloon Kyphoplasty Versus Standard Medical Treatment in Patients With Osteoporotic Vertebral Compression Fracture},
  url          = {http://dx.doi.org/10.1097/BRS.0b013e3182322d0f},
  volume       = {36},
  year         = {2011},
}