Abstract
BackgroundOsteoporotic vertebral compression fractures (OVCF) is a common and often debilitating complication of osteoporosis, leading to significant morbidity and increased mortality. Percutaneous vertebroplasty (PVP) and Percutaneous kyphoplasty (PKP) are recommendable surgical treatments for OVCF.ObjectiveTo evaluate PVP/PKP utilisation and their related direct medical costs for OVCF treatment in China from the payer perspective.MethodsA population-based medical claims database of a metropolitan city in China was analysed from the payer perspective, which included all inpatient claims from 01/01/2015 to 31/12/2017. All vertebral fractures patients that met the eligibility criteria (aged ≥50 years old, having vertebral fracture diagnosis, without unrelated diseases diagnoses such as tumour and scoliosis, received PVP/PKP) were deemed as OVCF patients. Baseline characteristics, surgery rate, length of stay in hospital, time to re-surgery, and costs (including costs per hospitalisation and annual costs) were described. Survival analysis function was used to estimate the re-surgery rate.ResultsOf the 50,686 patients with OVCF identified, 14,527 (28.66%) received a total number of 15,599 records of PVP/PKP surgeries from 2015 to 2017. Mean age was 75 at the first surgery captured in the database analysis period; females accounted for 79.54% of all cases. The median length of surgery stay was 9 days. Cumulative re-surgery rates were 1.22% in 30 days, 2.58% in 90 days, 3.61% in 183 days, 5.42% in 1 year, and 7.95% in 2 years. There was no significant difference in re-surgery rate between PVP and PKP (p = 0.3897). The median time to the re-surgery was 139 days. Mean costs per PVP/PKP-related hospitalisation were 35,906 CNY/5122 USD (34,195 CNY/4878USD for PVP, 44,414 CNY/6336 USD for PKP, p < 0.01). The overall costs of hospitalisation averaged 186.61 million CNY (26.62 million USD) per year in this metropolitan city.ConclusionFrom 2015 to 2017, nearly one-third of OVCF inpatients received PVP/PKP and the re-surgery rate was 7.95%. PVP/PKP procedures for OVCF place a high economic burden for both the healthcare system and patients. Early detection and treatment of patients with osteoporosis are critical in China.
Highlights
Osteoporotic vertebral compression fractures (OVCF) is a common and often debilitating complication of osteoporosis, leading to significant morbidity and increased mortality
There was no significant difference in re-surgery rate between Percutaneous vertebroplasty (PVP) and Percutaneous kyphoplasty (PKP) (p = 0.3897)
According to China’s guidelines, for surgical treatments, PVP is recommended for patients with OVCF who are refractory to treatment with braces and medication, but not suitable for patients with extremely severe vertebral compression fractures that cannot establish working channels and merge with the lesions of the same site requiring surgical treatment, pedicle fractures, severe compression fractures; PKP is recommended for pain or kyphosis caused by osteoporotic compression fracture, but not for stable, cured, painless osteoporotic compression fracture, osteoporotic burst fracture [1]
Summary
Osteoporotic vertebral compression fractures (OVCF) is a common and often debilitating complication of osteoporosis, leading to significant morbidity and increased mortality. Osteoporosis places significant disease burden on patients, ranking the seventh among common chronic diseases with over 200 million people affected worldwide [1, 2]. The prevalence of osteoporosis in mainland China was approximately 13% for adults aged 20 and over during the period of 1980–2008 and rose to about 28% for people aged 15 and over between 2012 and 2015 [3, 4] and the disease disproportionally affects females [4,5,6]. Osteoporotic vertebral compression fractures (OVCF) is a common and often debilitating complication of osteoporosis, leading to chronic back pain, insomnia, reduced activity, depression, and increased mortality [1]. A report shows that the total annual costs of OVCF in the United States in 2005 exceeded 1 billion USD; the average annual cost of OVCF in Germany between 2006 and 2010 was 6490 EUR (7203 USD/ 50,492 CNY); the direct medical cost of OVCF patients in Canada from 2011 to 2012 was 25,965 CAD (19,993 USD/136,316 CNY) per year; China’s one-year direct medical cost for OVCF patients from 2010 to 2012 was 21,474 CNY (3063 USD) [9,10,11,12]
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