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Survival and Cost Comparison of Kyphoplasty and Percutaneous Vertebroplasty Using German Claims Data

Lange, Ansgar Dipl Oec*; Kasperk, Christian MD; Alvares, Luisa MSc; Sauermann, Sven MD§; Braun, Sebastian PhD

doi: 10.1097/BRS.0000000000000135
Health Services Research

Study Design. Observational study.

Objective. Examine the overall survival and treatment costs from a third-party-payer perspective for patients with osteoporotic vertebral compression fractures (OVCFs) treated by vertebral augmentation or conservative treatment in Germany.

Summary of Background Data. OVCFs are associated with increased morbidity, mortality and thus reduced quality of life. Vertebral augmentation has been shown to be effective in these fractures. The association between treatment and survivorship as well as cost per life year gained for balloon kyphoplasty (BKP) and percutaneous vertebroplasty (PVP) was analyzed in the Medicare population. Replication of these analyses is warranted for confidence in findings.

Methods. Claims data from a major health insurance fund were used. Mortality risk differences between operated (BKP, PVP) and nonoperated cohorts were assessed by Cox regression. Operated patient groups were established by propensity score matching adjusting for covariates. For the matched operated patients with OVCF, (2006–2010) survival was estimated by Kaplan-Meier method.

Results. A total of 598 newly diagnosed patients with OVCF were operated of 3607 patients with OVCF. The operated cohort was 43% less likely to die than the nonoperated one in the 5-year study period (hazard ratio = 0.57; P < 0.001). Patients who received BKP had higher 60-month adjusted survival rate (66.7%) than those who received PVP (58.7%) (P = 0.68). Cumulative 4-year mean overall costs after first diagnosis were lower for the BKP cohort (PVP: €42,510 vs. BKP: €39,014). Initial upfront higher costs driven by surgical treatment for patients who received BKP are offset by considerable pharmacy costs in patients who received PVP. There were differences between the values of painkiller consumption (PVP: €3321 vs. BKP: €2224).

Conclusion. Results suggest a higher overall survival rate for operated than nonoperated patients with OVCF and indicate a potential survival benefit for patients who received BKP compared with patients who received PVP. The reasons merit further investigation. Total costs were lower after 4 years for patients who received BKP versus PVP due to less consumption of pharmaceuticals.

Level of Evidence: 3

Supplemental Digital Content is Available in the Text.Observational study about survival and costs of patients with osteoporotic vertebral compression fractures in Germany. Results suggest that the survival rate of operated patients was higher than that of nonoperated patients and indicate a potential survival benefit for balloon kyphoplasty (BKP) compared with percutaneous vertebroplasty (PVP). Total costs were lower after 4 years for patients who received BKP than for those who received PVP due to less consumption of pharmaceuticals.

*Leibniz University Hannover, Center for Health Economics Research Hannover, Germany

University of Heidelberg, Heidelberg, Germany

Spine and Biologics, Medtronic International, Tolochenaz, Switzerland

§Spine and Biologics, Medtronic GmbH, Meerbusch, Germany; and

Herescon GmbH, Health Economic Research & Consulting, Hannover, Germany.

Address correspondence and reprint requests to Ansgar Lange, Dipl Oec, Leibniz University Hannover, Center for Health Economics Research Hannover, Koenigsworther Platz 1, D-30167 Hannover, Germany; E-mail:

Acknowledgment date: June 17, 2013. First revision date: September 23, 2013. Second revision date: November 4, 2013. Acceptance date: November 8, 2013.

The device(s)/drug(s) is/are FDA-approved or approved by corresponding national agency for this indication.

Medtronic International funds were received to support this work.

Relevant financial activities outside the submitted work: board membership, consulting fee or honorarium, fees for participation in review activities, payment for writing or reviewing the manuscript, consultancy, payment for lectures, stock/stock options, support for travel and travel/accommodations/meeting expenses.

© 2014 by Lippincott Williams & Wilkins