Cost-utility analysis of vertebroplasty versus thoracolumbosacral orthosis in the treatment of traumatic vertebral fractures
Résumé
In this research we compared the cost-utility of vertebroplasty versus
bracing for treatment of post-traumatic fractures. Cost and health outcomes were
assessed from a prospective, randomized, non-blinded, single-center study that
was carried out between May 2010 and November 2011 at the University Hospital
of Clermont-Ferrand, France. The study included 99 patients, aged from 18 years
to 70 years, suffering from acute non-osteoporotic vertebral fracture. We
compared the costs and Quality-Adjusted Life Years (QALY) and assessed the
Incremental Cost-Effectiveness Ratio for the two arm groups. Health insurance
and patient perspectives were considered. From the health insurance perspective,
total cost was €7,267 for the brace group whereas it was €7,365 for the
vertebroplasty group (mean difference €75.3; p <0.9). From the patient
perspective, total cost was €5,303 for the brace group and €3,435 for the
vertebroplasty group (mean difference €-1,900.7; p<0.02). Differences between
groups in QALYs were non-significant: 0.01 (95% CI -0.01 to 0.04; p=0.5). The
Incremental Cost-Effectiveness Ratio of vertebroplasty was €-12,200 per QALY
from the health insurance perspective and €-159,200 per QALY from the patient
perspective. While the QALY values do not differ between the two groups, the
vertebroplasty technique resulted in significantly lower costs from the patient
perspective in France. From the health insurance perspective, we were unable to
conclude if vertebroplasty was more cost-effective than bracing.