Vertebral Augmentation Involving Vertebroplasty or Kyphoplasty for Cancer-Related Vertebral Compression Fractures: An Economic Analysis

Abstract

Background: Untreated vertebral compression fractures can have serious clinical consequences and impose a considerable impact on patients' quality of life and on caregivers. Since non-surgical management of these fractures has limited effectiveness, vertebral augmentation procedures are gaining acceptance in clinical practice for pain control and fracture stabilization. The objective of this analysis was to determine the cost-effectiveness and budgetary impact of kyphoplasty or vertebroplasty compared with non-surgical management for the treatment of vertebral compression fractures in patients with cancer.

Methods: We performed a systematic review of health economic studies to identify relevant studies that compare the cost-effectiveness of kyphoplasty or vertebroplasty with non-surgical management for the treatment of vertebral compression fractures in adults with cancer. We also performed a primary cost-effectiveness analysis to assess the clinical benefits and costs of kyphoplasty or vertebroplasty compared with non-surgical management in the same population. We developed a Markov model to forecast benefits and harms of treatments, and corresponding quality-adjusted life years and costs. Clinical data and utility data were derived from published sources, while costing data were derived using Ontario administrative sources. We performed sensitivity analyses to examine the robustness of the results. In addition, a 1-year budget impact analysis was performed using data from Ontario administrative sources. Two scenarios were explored: (a) an increase in the total number of vertebral augmentation procedures performed among patients with cancer in Ontario, maintaining the current proportion of kyphoplasty versus vertebroplasty; and (b) no increase in the total number of vertebral augmentation procedures performed among patients with cancer in Ontario but an increase in the proportion of kyphoplasties versus vertebroplasties.

Results: The base case considered each of kyphoplasty and vertebroplasty versus non-surgical management. Kyphoplasty and vertebroplasty were associated with an incremental cost-effectiveness ratio of $33,471 and $17,870, respectively, per quality-adjusted life-year gained. The budgetary impact of funding vertebral augmentation procedures for the treatment of vertebral compression fractures in adults with cancer in Ontario was estimated at about $2.5 million in fiscal year 2014/15. More widespread use of vertebral augmentation procedures raised total expenditures under a number of scenarios, with costs increasing by $67,302 to $913,386.

Conclusions: Our findings suggest that the use of kyphoplasty or vertebroplasty in the management of vertebral compression fractures in patients with cancer may be a cost-effective strategy at commonly accepted willingness-to-pay thresholds. Nonetheless, more widespread use of kyphoplasty (and vertebroplasty to a lesser extent) would likely be associated with net increases in health care costs.

Figure 1:. PRISMA Flow Diagram

Figure 2:. Analytic Overview

Figure 3:. Markov Model Structure

Figure 4:. Survival After Diagnosis of Vertebral Compression Fracture in Patients With Cancer, by Cancer Type

Figure 5:. Utility Gains Assumed in Economic Model

Figure 6:. Key Findings From Univariate Sensitivity Analyses for Kyphoplasty Versus Non-surgical Management

Figure 7:. All Kyphoplasties and Vertebroplasties Performed in Ontario from FY 2008/09 to 2014/15

Figure 8:. All Kyphoplasties and Vertebroplasties Performed in Ontario at an Ontario Hospital in 2013/14, by Cause of Fracture (Cancer or Non-cancer)

Figure 9:. Results of Budget Impact for Scenario 1: Increasing Total Vertebral Augmentation Procedures and Maintaining Current Proportion of Kyphoplasties Versus Vertebroplasties

Figure 10:. Results of Budget Impact for Scenario 2: No Increase in Total Vertebral Augmentation Procedures but Increasing Proportion of Kyphoplasties Versus Vertebroplasties