An Evaluation of the Utility and Cost-Effectiveness of Kyphoplasty for the Treatment of Vertebral Fractures

Methods: 100 patients with 1-3 vertebral fractures treated with kyphoplasty completed SF-36 questionnaires pre-operatively and 2 years post-operatively. Changes in SF-36 sub-domains from pre-operative evaluation to 2 year follow-up were compared with age and sex-matched controls. Data were converted to Quality Adjusted Life Years (QALYs) using the Brazier method (Sheffield, UK). Cost data for kyphoplasty were utilized to compute the average cost/QALY for inpatient and outpatient kyphoplasty.

Results: 80% of patients had 1 level kyphoplasty, with 16% and 4% undergoing 2 and 3 level kyphoplasty respectively. Significant increases in SF-36 scores were observed after kyphoplasty in physical function, role physical, bodily pain, vitality, social function, emotional health, and mental health. Average change in health-related quality of life was .16 per year (range -.146 to .423), yielding an average gain of .32 QALYs for patients at 2 year follow-up. Cost/QALY was $11,856 for outpatient kyphoplasty and $23,292 for inpatient. No cost difference was observed for thoracic versus lumbar fractures.

Conclusions: Kyphoplasty effectively improves pain and function for patients 2 years post-operatively and is cost-effective even if health benefits only extend 2 years. Of note, the cost/QALY of outpatient kyphoplasty is only slightly greater than that of total hip arthroplasty, a well-established cost-effective procedure, estimated to be $10,000/QALY, and it is much more cost-effective than CABG, estimated at more than $100,000/QALY by several analyses. The cost/QALY decreases proportionally every year that improvement in health extends beyond 2 years. Therefore, these data represent the upper limit of cost/QALY. For each year that kyphoplasty benefits the patients' health beyond 2 years, the cost/QALY continues to decrease, continuing to improve cost-effectiveness.