EVALUATION OF THE TREATMENT COSTS AFTER BALLOON KYPHOPLASTY VERSUS CONSERVATIVE TREATMENT IN OSTEOPOROTIC VERTEBRAL FRACTURES – AN ECONOMICAL ANALYSIS

Abstract

Operative treatment of osteoporotic vertebral fractures seems to result in higher primary costs compared to conservative treatment. However it is still unclear whether the inpatient related follow-up costs don’t result in a different outcome.

The aim of this analysis was a nationwide comparison of spine related inpatient treatments after balloon kyphoplasty versus conservative treatment of balloon kyphoplasty patients.

Materials and Methods: 110 patients after conservative treatment and 141 patients after balloon kyphoplasty treated primarily between 2002 and 2005 in one center were followed up via a nationwide analysis of spine related inhospital treatment.

Data from the Austrian DRG-system, which includes all inpatients treated in Austria have been used to identify admission of the target population between 2002 and 2006. Because no unique patient identifier is available in the data set, a matching according to data of birth, gender and postal code was used. Outpatient visits are not included. From these data the number of admissions, the length of stay and the scores can be determined. Furthermore each admission was classified as spine related or not.

To calculate the exact follow up times the data were matched against the Austrian death registry. If a patient has died this data was used to calculate the follow up time otherwise December 31st 2006 was used.

The mean age of the conservative group was 75.49 and of the kyphoplasty group 71.16 years.

The total follow up time was 324.55 years(mean +standard deviation 2.92+−1.40) for the conservative and 354.25 (2.53+−0.96) for the kyphoplasty group. The shorter mean follow up interval for the kyphoplasty group is due to the fact that in the years 2004 and 2005 more patients have been treated by kyphoplasty.

Results: The mean number of admissions in the kyphoplasty group is 0.779 or 0.308 per follow up year whereas in the conservative group these figures are approximately twice, namely 1.757 and 0.601. Considering the average length of stay the kyphoplasty group shows less inhospital days (9.2 per patient or 3.6 per follow up year), whereas in the conservative group this is 14.4 and 4.6 inpatient days. Finally the scores per admission in the follow up period are lower in the kyphoplasty group (3146 and 1243 DRG related treatment points) whereas in the conservative group these values are 3824 and 1308.

Conclusion: These data show a strong superiority of kyphoplasty compared to conservative treatment of spine problems based on the data of one big hospital in Austria where 251 patients have been treated between 2002 and 2005.

We demonstrate a long term superiority of balloon kyphoplasty compared to non-surgical treatment regarding inpatient treatments.