Abstract
BACKGROUND AND PURPOSE: Evidence from randomized controlled trials for the efficacy of vertebral augmentation in vertebral compression fractures has been mixed. However, claims-based analyses from national registries or insurance datasets have demonstrated a significant mortality benefit for patients with vertebral compression fractures who receive vertebral augmentation. The purpose of this study was to calculate the number needed to treat to save 1 life at 1 year and up to 5 years after vertebral augmentation.
MATERIALS AND METHODS: A 10-year sample of the 100% US Medicare data base was used to identify patients with vertebral compression fractures treated with nonsurgical management, balloon kyphoplasty, and vertebroplasty. The number needed to treat was calculated between augmentation and nonsurgical management groups from years 1–5 following a vertebral compression fracture diagnosis, using survival probabilities for each management approach.
RESULTS: The adjusted number needed to treat to save 1 life for nonsurgical management versus kyphoplasty ranged from 14.8 at year 1 to 11.9 at year 5. The adjusted number needed to treat for nonsurgical management versus vertebroplasty ranged from 22.8 at year 1 to 23.8 at year 5.
CONCLUSIONS: Both augmentation modalities conferred a prominent mortality benefit over nonsurgical management in this analysis of the US Medicare registry, with a low number needed to treat. The calculations based on this data base resulted in a low number needed to treat to save 1 life at 1 year and at 5 years.
ABBREVIATIONS:
- BKP
- balloon kyphoplasty
- NNT
- number needed to treat
- NSM
- nonsurgical management
- VCF
- vertebral compression fracture
- VP
- vertebroplasty
Footnotes
Disclosures: Joshua A. Hirsch—UNRELATED: Consultant: Medtronic, Data Monitoring Committee: Relievant, Data and Safety Monitoring Board Service, Ceranovus;Grants/Grants Pending: Neiman Health Policy Institute, Comments: health policy; I am an affiliate senior research fellow at Neiman.* Douglas Beall—UNRELATED: Board Membership: Spintec, Nocimed; Consultancy: Medtronic, Spineology, Merit Medical, Eli LIlly, Johnson & Johnson, Spintec, Imaging3, IZI, Medlantis, Techlamed; Consultant: Peterson Enterprises, Medical Metrics, Radius Pharmaceuticals, Avanos Medical, Vertiflex, Sollis Pharma, Simplify Medical, Stryker, Lenoss Medical, Spine BioPharma; Grants/Grants Pending: Medtronic, Spintec, Medical Metrics, Avanos Medical, Relievant Medsystems, Vertiflex, Stryker, Sollis Pharma, Simplify Medical, Lenoss Medical, Spine BioPharma; Payment for Lectures Including Service on Speakers Bureaus: Medtronic, Spineology, Merit Medical, Eli LIlly, Johnson & Johnson, Spintec, Imaging3, IZI, Medlantis, Techlamed; Consultant: Peterson Enterprises, Medical Metrics, Radius Pharmaceuticals, Avanos Medical, Vertiflex, Sollis Pharma, Simplify Medical, Stryker, Lenoss Medical, Spine BioPharma; Royalties: Vivex Biologics, BioPharma; Payment for Development of Educational Presentations: Medtronic, Merit, Stryker, Vertiflex; Stock/Stock Options: Artio, Sophiris, Eleven Biotherapeutics, Radius Pharmaceuticals, FlowForward Medical, Lenoss Medical, Spine BioPharma; Travel/Accommodations/Meeting Expenses Unrelated to Activities Listed: Medtronic, Spineology, Merit Medical, Eli LIlly, Johnson & Johnson, Spintec, Imaging3, IZI, Medlantis, Techlamed, Consultant: Peterson Enterprises, Medical Metrics, Radius Pharmaceuticals, Avanos Medical, Vertiflex, Sollis Pharma, Simplify Medical, Stryker, Lenoss Medical, Spine BioPharma. Michael Frohbergh—UNRELATED: Employment: Exponent Inc. Kevin Ong—UNRELATED: Other: Medtronic, Stryker Orthopaedics, Sanofi, Ferring Pharmaceuticals, Paradigm Spine, Pacira Pharmaceuticals, St. Jude Medical, Relievant Medsystems, International Society for the Advancement of Spine Surgery, Zimmer Biomet, Joerns Healthcare, SpineFrontier, SI-Technology, Ethicon, DJO Global, Össur, Karl Storz Endoscopy-America, Comments: I am an employee and shareholder of Exponent, a scientific and engineering consulting firm. Exponent has been paid fees for my consulting services on behalf of such companies and suppliers.* *Money paid to the institution.
- © 2019 by American Journal of Neuroradiology
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