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Cost-effectiveness of balloon kyphoplasty in patients with symptomatic vertebral compression fractures in a UK setting

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Abstract

Summary

Balloon kyphoplasty (BKP) is a procedure used to treat vertebral compression fractures (VCFs). We developed a cost-effectiveness model to evaluate BKP in United Kingsdom patients with hospitalised VCFs and estimated the cost-effectiveness of BKP compared to non-surgical management. The results indicate that BKP provides a cost-effective alternative for treating these patients.

Introduction

VCFs of osteoporotic patients are associated with chronic pain, a reduction in health-related quality of life (QoL) and high healthcare costs. BKP is a minimally invasive procedure that has resulted in pain relief, vertebral body height-restoration, decreased kyphosis and improved physical functioning in patients with symptomatic VCFs. BKP was shown to improve health-related QoL in a 12-month interim analysis of a randomised phase-III trial.

Methods

The objectives of this study were to develop a Markov cost-effectiveness model to evaluate BKP in patients with painful hospitalised VCFs and to estimate the cost-effectiveness of BKP compared with non-surgical management in a UK setting. It was assumed that QoL-benefits found at 12 months linearly approached zero during another 2 years, and that patients receiving BKP warranted six fewer hospital bed days compared with patients given non-surgical management.

Results

The procedure was associated with quality-adjusted life-years (QALY)-gains of 0.17 and cost/QALY-gains at £8,800. The results were sensitive to assumptions about avoided length of hospital-stay and persistence of kyphoplasty-related QoL-benefits.

Conclusion

In conclusion, the results indicate that BKP provides a cost-effective alternative for treating patients with hospitalised VCFs in a UK-setting.

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References

  1. Cummings SR, Melton LJ (2002) Epidemiology and outcomes of osteoporotic fractures. Lancet 359:1761–1767

    Article  PubMed  Google Scholar 

  2. (1998) Report on osteoporosis in the European community—action for prevention. In. European Commission–Employment and Social Affairs

  3. Strom O, Borgstrom F, Zethraeus N, Johnell O, Lidgren L, Ponzer S, Svensson O, Abdon P, Ornstein E, Lunsjo K, Thorngren KG, Sernbo I, Rehnberg C, Jonsson B (2007) Long-term costs and quality of life associated with osteoporosis-related fractures in Sweden. Acta Orthopaedica 79(2):269–80

    Google Scholar 

  4. Borgstrom F, Zethraeus N, Johnell O, Lidgren L, Ponzer S, Svensson O, Abdon P, Ornstein E, Lunsjo K, Thorngren KG, Sernbo I, Rehnberg C, Jonsson B (2006) Costs and quality of life associated with osteoporosis-related fractures in Sweden. Osteoporos Int 17:637–650

    Article  PubMed  Google Scholar 

  5. Kanis JA, Johnell O, Oden A, Borgstrom F, Zethraeus N, De Laet C, Jonsson B (2004) The risk and burden of vertebral fractures in Sweden. Osteoporos Int 15:20–26

    Article  CAS  PubMed  Google Scholar 

  6. Kasperk C, Hillmeier J, Noldge G, Grafe IA, Dafonseca K, Raupp D, Bardenheuer H, Libicher M, Liegibel UM, Sommer U, Hilscher U, Pyerin W, Vetter M, Meinzer HP, Meeder PJ, Taylor RS, Nawroth P (2005) Treatment of painful vertebral fractures by kyphoplasty in patients with primary osteoporosis: a prospective nonrandomized controlled study. J Bone Miner Res 20:604–612

    Article  PubMed  Google Scholar 

  7. Taylor RS, Taylor RJ, Fritzell P (2006) Balloon kyphoplasty and vertebroplasty for vertebral compression fractures: a comparative systematic review of efficacy and safety. Spine 31:2747–2755

    Article  PubMed  Google Scholar 

  8. Grafe IA, Da Fonseca K, Hillmeier J, Meeder PJ, Libicher M, Noldge G, Bardenheuer H, Pyerin W, Basler L, Weiss C, Taylor RS, Nawroth P, Kasperk C (2005) Reduction of pain and fracture incidence after kyphoplasty: 1-year outcomes of a prospective controlled trial of patients with primary osteoporosis. Osteoporos Int 16:2005–2012

    Article  PubMed  Google Scholar 

  9. Briggs AM, Wrigley TV, van Dieen JH, Phillips B, Lo SK, Greig AM, Bennell KL (2006) The effect of osteoporotic vertebral fracture on predicted spinal loads in vivo. Eur Spine J 15:1785–1795

    Article  PubMed  Google Scholar 

  10. Lindsay R, Silverman SL, Cooper C, Hanley DA, Barton I, Broy SB, Licata A, Benhamou L, Geusens P, Flowers K, Stracke H, Seeman E (2001) Risk of new vertebral fracture in the year following a fracture. JAMA 285:320–323

    Article  CAS  PubMed  Google Scholar 

  11. Komp M, Ruetten S, Godolias G (2004) Minimally invasive therapy for functionally unstable osteoporosis vertebral fracture by means of kyphoplasty: prospective comparative study of 19 surgically and 17 conservatively treated patients. J Miner Stoffwechs 11(suppl 1):13–15 in German

    Google Scholar 

  12. Taylor RS, Fritzell P, Taylor RJ (2007) Balloon kyphoplasty in the management of vertebral compression fractures: an updated systematic review and meta-analysis. Eur Spine J 16(8):1085–1100

    Article  PubMed  Google Scholar 

  13. Fribourg D, Tang C, Sra P, Delamarter R, Bae H (2004) Incidence of subsequent vertebral fracture after kyphoplasty. Spine 29:2270–2276 discussion 2277

    Article  PubMed  Google Scholar 

  14. Strom O, Borgstrom F, Sen SS, Boonen S, Haentjens P, Johnell O, Kanis JA (2007) Cost-effectiveness of alendronate in the treatment of postmenopausal women in 9 European countries—an economic evaluation based on the fracture intervention trial. Osteoporos Int 18:1047–1061

    Article  CAS  PubMed  Google Scholar 

  15. Borgstrom F, Jonsson B, Strom O, Kanis JA (2006) An economic evaluation of strontium ranelate in the treatment of osteoporosis in a Swedish setting: based on the results of the SOTI and TROPOS trials. Osteoporos Int 17:1781–1793

    Article  CAS  PubMed  Google Scholar 

  16. Kanis JA, Borgstrom F, Johnell O, Jonsson B (2004) Cost-effectiveness of risedronate for the treatment of osteoporosis and prevention of fractures in postmenopausal women. Osteoporos Int 15(11):862–71

    Article  CAS  PubMed  Google Scholar 

  17. Fleurence RL, Iglesias CP, Johnson JM (2007) The cost effectiveness of bisphosphonates for the prevention and treatment of osteoporosis: a structured review of the literature. PharmacoEconomics 25:913–933

    Article  CAS  PubMed  Google Scholar 

  18. National Statistics the official UK statistics site. In. http://www.statistics.gov.uk/

  19. NICE (2008) Guide to the methods of technology appraisal. http://wwwniceorguk/media/B52/A7/TAMethodsGuideUpdatedJune2008pdf

  20. Wardlaw D, Cummings SR, Van Meirhaeghe J, Bastian L, Tillman JB, Ranstam J, Eastell R, Shabe P, Talmadge K, Boonen S (2009) Efficacy and safety of balloon kyphoplasty compared with non-surgical care for vertebral compression fracture (FREE): a randomised controlled trial. Lancet 373:1016–1024

    Article  PubMed  Google Scholar 

  21. Dolan P (1997) Modeling valuations for EuroQol health states. Med Care 35:1095–1108

    Article  CAS  PubMed  Google Scholar 

  22. Sonnenberg FA, Beck JR (1993) Markov models in medical decision making: a practical guide. Med Decis Making 13:322–338

    Article  CAS  PubMed  Google Scholar 

  23. Kind P, Dolan P, Gudex C, Williams A (1998) Variations in population health status: results from a United Kingdom national questionnaire survey. Br Med J 316:736–741

    CAS  Google Scholar 

  24. Ledlie JT, Renfro MB (2006) Kyphoplasty treatment of vertebral fractures: 2-year outcome show sustained benefits. Spine 31:57–64

    Article  PubMed  Google Scholar 

  25. Grafe I, DeFonseca K, Hillmeier JP-JM, Libicher M, Nodge G, Ommer M, Hilscher UCK (2006) Kyphoplasty persistently reduces pain in patients with osteoporotic vertebral compression fractures—3-year outcome of a prospectively controlled cohort study. IOF World Congress of Osteoporosis Toronto, Canada

  26. Singer BR, McLauchlan GJ, Robinson CM, Christie J (1998) Epidemiology of fractures in 15, 000 adults: the influence of age and gender. J Bone Jt Surg Br 80:243–248

    Article  CAS  Google Scholar 

  27. Kanis JA, Johnell O, Oden A, Sembo I, Redlund-Johnell I, Dawson A, De Laet C, Jonsson B (2000) Long-term risk of osteoporotic fracture in Malmö. Osteoporos Int 11:669–674

    Article  CAS  PubMed  Google Scholar 

  28. Puffer S, Torgerson DJ, Sykes D, Brown P, Cooper C (2004) Health care costs of women with symptomatic vertebral fractures. Bone 35:383–386

    Article  PubMed  Google Scholar 

  29. Stevenson M, Davis S, Kanis J (2006) The hospitalization costs and outpatient costs of fragility fractures. Women’s Health Med 4:149–151

    Article  Google Scholar 

  30. Curtis L (2008) Unit Costs of Health and Social Care. In. Personal Social Services Research Unit, University of Kent, http://www.pssru.ac.uk/uc/uc2008contents.htm

  31. Taylor R (2008) Cost-effectiveness of balloon kyphoplasty for symptomatic vertebral compression fractures in osteoporotic patients. Osteoporos Int Suppl 1 (P146)

  32. Swedish National Inpatient Register and Causes of Death Register. In. The Swedish National Board of Health Centre—The Epidemiological Centre, http://www.sos.se/epc/epceng.htm

  33. Kanis JA, Oden A, Johnell O, De Laet C, Jonsson B (2004) Excess mortality after hospitalisation for vertebral fracture. Osteoporos Int 15:108–112

    Article  PubMed  Google Scholar 

  34. Efron B, Tibshirani RJ (1993) An Introduction to the Bootstrap. Chapman & Hall, London

    Google Scholar 

  35. Atalay B, Caner H, Gokce C, Altinors N (2005) Kyphoplasty: 2 years of experience in a neurosurgery department. Surg Neurol 64(Suppl 2):S72–S76

    Article  PubMed  Google Scholar 

  36. Dudeney S, Lieberman IH, Reinhardt MK, Hussein M (2002) Kyphoplasty in the treatment of osteolytic vertebral compression fractures as a result of multiple myeloma. J Clin Oncol 20:2382–2387

    Article  CAS  PubMed  Google Scholar 

  37. Lane JM, Hong R, Koob J, Kiechle T, Niesvizky R, Pearse R, Siegel D, Poynton AR (2004) Kyphoplasty enhances function and structural alignment in multiple myeloma. Clin Orthop Relat Res 429:49–53

    Article  Google Scholar 

  38. Ledlie JT, Renfro M (2003) Balloon kyphoplasty: one-year outcomes in vertebral body height restoration, chronic pain, and activity levels. J Neurosurg 98:36–42

    PubMed  Google Scholar 

  39. Lieberman I, Reinhardt MK (2003) Vertebroplasty and kyphoplasty for osteolytic vertebral collapse. Clin Orthop Relat Res S176-S186

  40. Edidin AA, Ong K, Lau E, Kurtz SM (2009) Mortality Risk for Operated and Non-Operated Vertebral Fracture Patients in the Medicare Population. American Academy of Orthopaedic Surgeons, Annual Meeting (podium presentation abstract) http://www3.aaos.org/education/anmeet/anmt2009/podium/podium.cfm?Pevent=312

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Acknowledgements

We would like to extend our gratitude to Professors Torgerson and Greiner who generously offered access to data relevant for this study.

Conflicts of interest

Financial support was obtained via an unrestricted grant from Medtronic. Catherine Leonard is an employee of Medtronic Ltd, UK. David Marsh and Cyrus Cooper have received honoraria as expert advisors to Medtronic.

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Authors and Affiliations

  1. i3 Innovus, Stockholm, Sweden

    O. Ström

  2. Medical Management Center, Karolinska Institutet, Stockholm, Sweden

    O. Ström

  3. Medtronic Ltd, Watford, UK

    C. Leonard

  4. Royal National Orthopaedic Hospital, Stanmore, UK

    D. Marsh

  5. MRC Epidemiology Resource Centre, University of Southampton, Southampton, UK

    C. Cooper

  6. Institute of Musculoskeletal Sciences, University of Oxford, Oxford, UK

    C. Cooper

  7. Klarabergsviadukten 90, hus D, 2 tr, 111 64, Stockholm, Sweden

    O. Ström

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  1. O. Ström
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Correspondence to O. Ström.

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Ström, O., Leonard, C., Marsh, D. et al. Cost-effectiveness of balloon kyphoplasty in patients with symptomatic vertebral compression fractures in a UK setting. Osteoporos Int 21, 1599–1608 (2010). https://doi.org/10.1007/s00198-009-1096-6

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  • DOI: https://doi.org/10.1007/s00198-009-1096-6

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