Health Care Costs and Financing

The volume and charges for vertebroplasty performed in Medicare patients doubled from 2001 to 2005, but rates varied considerably by State

Each year up to 200,000 American women aged 50 years and older suffer a vertebral fracture, usually due to osteoporosis. The volumes, rates, and inflation-adjusted costs for vertebroplasty, a nonsurgical procedure to stabilize compressed vertebrae, doubled for Medicare fee-for-service patients from 2001 to 2005, according to a new study. In vertebroplasty, the physician uses specialized imaging equipment to guide injection of surgical cement into the collapsed area of the spine in order to stabilize the vertebra and alleviate pain.

Medicare-approved charges approximate direct medical costs from a societal perspective.

Patients in Medicare fee-for-service plans received about twice as many vertebroplasties in 2005 as they had in 2001 (mean of 75 vs. 35.4/100,000). However, rates in individual States differed, and also increased to varying degrees, ranging from 0.0 to 515.6/100,000 in 2001 to 9.8 to 849.5/100,000 in 2005. Fluoroscopic, rather than computed tomography, guidance was used in 98.7 percent of cases overall. Although vertebroplasty was predominantly an outpatient procedure, inpatient cases generated most of the costs. While use of ambulatory surgery centers and physicians' offices was relatively uncommon, increasing volumes and costs for such procedures may mirror earlier trends in the growth of outpatient lumbar spine surgery identified using Healthcare Cost and Utilization Project data.

Costs for the procedure also rose, with inflation-adjusted nationwide direct medical costs for Medicare fee-for-service patients alone doubling from $76 million in 2001 to $154 million in 2005. Given the issues surrounding appropriate vertebroplasty use, future practice patterns, such as postprocedural monitoring after outpatient spinal procedures and outcomes for all patients, should be closely tracked, recommend Darryl T. Gray, M.D., Sc.D., of the Agency for Healthcare Research and Quality, and colleagues.

See "Costs and state-specific rates of thoracic and lumbar vertebroplasty, 2001-2005," by Dr. Gray, William Hollingworth, Ph.D., Nneka Onwudiwe, Pharm.D., and Jeffrey G. Jarvik, M.D., M.P.H., in Spine 33(17), pp. 1905-1912, 2008. Reprints (AHRQ Publication No. 09-R015) are available from the AHRQ Publications Clearinghouse.

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