Wednesday, September 26, 2018 1:00 PM – 2:00 PM Spinal Trauma: 54. Nonsurgical management versus cement augmentation versus transpedicular instrumented stabilization for the treatment of osteoporotic compression fractures: a cost-effectiveness analysis

Abstract

BACKGROUND CONTEXT Historically, despite the mainstay of osteoporotic vertebral compression fracture (OVCF) treatment being nonsurgical management (NSM), patients often had persistent symptoms with objective sequalae that continued to significantly impair their quality of life and activities of daily living. Cement augmentation (CA) subsequently emerged as a safe, and cost-effective alternative. However, morbidity and mortality, despite this treatment, remains high. Transpedicular instrumented stabilization (TPIS) has traditionally been advised against due to an unacceptably high failure rate in this elderly cohort; however, the efficacy of surgery has not been revisited following advances in surgical optimization and surgical techniques. PURPOSE We sought to perform a cost-effective analysis via a Markov model for the treatment of OVCF fracture with either NSM, CA, or TPIS. STUDY DESIGN/SETTING A Markov state-transition decision model was constructed to estimate the cumulative economic benefit of managing OVCF with NSM versus CA versus TPIS. PATIENT SAMPLE In the model, a hypothetical 70-year-old patient who sustained an OVCF was analyzed. OUTCOME MEASURES A cost-effectiveness analysis was performed that yielded: cost-effectiveness (cost per quality adjusted life years [QALY]), incremental cost-effectiveness ratio, net monetary benefit of each treatment compared to others, and a one-way and two-way sensitivity analysis. METHODS A Markov analysis was performed. Variables included in the model are: QALY, success rates, complication and mortality rates and costs. These variables were derived from recent peer-reviewed articles, mostly randomized controlled trials. RESULTS Assuming patients entered the cycle at age 70, NSM corresponded with a 5.02 QALY gain over the remainder of the patient's life, CA corresponded with an 8.04 QALY gain, and TPIS corresponded with a 0.31 QALY loss. CA was the most cost-effective treatment, followed by NSM. TPIS was not cost-effective. Additional cost per unit of effectiveness gained when comparing CA to NSM was $11,166.76. CONCLUSIONS In our study, TPIS was both less effective and more expensive compared to the cheapest treatment, hence it was dominated, and by definition, not cost-effective. However, CA may be a cost-effective alternative for the treatment of OVCF compared to NSM. The additional cost per unit of effectiveness gained from CA, compared to NSM, was five times lower than the WTP standard of $50,000. FDA DEVICE/DRUG STATUS This abstract does not discuss or include any applicable devices or drugs.