Comparison of Vertebroplasty, Kyphoplasty, and Nonsurgical Management of Vertebral Compression Fractures and Impact on US Healthcare Resource Utilization

STUDY DESIGN Retrospective propensity score-matched cohort analysis of the Thomson Reuters MarketScan database. PURPOSE To compare the outcomes of vertebral compression fracture (VCF) treatment options, with an emphasis on reoperation, complications, costand overall healthcare resource use between 2005 and 2009 in the United States. OVERVIEW OF LITERATURE Options for the treatment of VCFs include conservative management, kyphoplasty, and vertebroplasty. The cost-effectiveness of surgical intervention for VCF has been criticized, and some suggest their outcomes to be similar to placebo. METHODS Patients 18 years of age and older who developed a VCF were identified and separated into three treatment cohorts: vertebroplasty, kyphoplasty, and non-surgical. Propensity score matching was performed to match patients between cohorts. Main outcomes assessed included reoperation, complications, healthcare resource use and associated cost. Outcomes were compared at three separate time intervals (patients at index hospitalization; patients with at least 2-year follow-up data; and those with at least 4-year follow-up data). RESULTS Twenty thousand seven hundred forty patients were identified with VCFs, yielding 7,290 after propensity score matching. The mean age of the patients was 78±12 years; and 5,507 (75.5%) were female. All reoperation rates ranged from 6%-17%, while complication rates ranged from 7%-10%, which did not differ significantly among the three cohorts at all follow-up periods. Overall costs were noted to be significantly greater in both the kyphoplasty and vertebroplasty groups at 1-year follow-up, not at 2-year and 4-year follow-up. CONCLUSIONS Our data suggests that the treatment of a VCF patient will likely be associated with similar long-term operative and complication rates regardless of treatment modality.