Cost-utility Analysis of Vertebroplasty versus Thoracolumbosacral Orthosis in the Treatment of Traumatic Vertebral Fractures

Nadia Yakhelef (1) , Martine Audibert (1) , Bruno Peirera (2) , Antoine Mons (3) , Emmanuel Chabert (3)

1 CERDI - Centre d'Études et de Recherches sur le Développement International
2 DRCI - Délégation à la recherche clinique et à l'innovation
3 CHU Gabriel Montpied [Clermont-Ferrand]

Purpose: To evaluate the cost-utility of Vertebroplasty versus conservative therapy (Thoracolumbosacral orthosis) for treatment of post-traumatic non-osteoporotic and/or non-neoplastic fractures. Materials and Methods: A prospective, randomized, non-blinded, single-center study was carried out between 2010 and 2013. The study included 99 patients, aged from 18 years to 70 years, suffering from acute non-osteoporotic vertebral fracture. We compared costs and Quality-Adjusted Life Years and assessed the Incremental Cost-Effectiveness Ratio for the two arm groups. Health insurance, patient and societal perspectives are considered. Results: For health insurance perspective, total cost was €7,267 for the brace group versus €7,365 for the vertebroplasty group (mean difference €75.3; p <0.9). For 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). For societal perspective, total cost was €13,071 for the brace group and €14,289 for the vertebroplasty group (mean difference €1,165, p <0.36). Differences between groups in QALY were non-significant: 0.01 (95% CI -0.01; 0.04 p=0.5). The Incremental Cost-Effectiveness Ratio was €-12,200 for the health insurance perspective, €159,200 for the patient perspective and €119,466 for societal perspective. Conclusion: The difference in QALYs does not differ between the two groups, but the vertebroplasty technique results in significantly lower costs from a patient perspective. From societal and health insurance perspectives, we are unable to conclude if the vertebroplasty was more cost-effective than Thoracolumbosacral orthosis.

Mots clés: Health economic assessment; Cost-utility; QALY; SF-36; SF-6D; Vertebroplasty; TLSO; Clinical

Domaines: Economies et finances

Nadia Yakhelef, Martine Audibert, Bruno Peirera, Antoine Mons, Emmanuel Chabert. Cost-utility Analysis of Vertebroplasty versus Thoracolumbosacral Orthosis in the Treatment of Traumatic Vertebral Fractures. 2015. ⟨halshs-01241824⟩