PMD23 Health Care Utilization and Costs in Patients Experiencing Bone Fracture Nonunion

Abstract

OBJECTIVES: There has been recent controversy regarding the effectiveness of vertebral augmentation (balloon kyphoplasty (BKP) and vertebroplasty (VP)) for treating vertebral compression fractures (VCFs). Limited cost comparisons of BKP and VP suggest that initial hospital costs are higher for BKP (Mehio 2011), however costs for subsequent post-operative care are unknown. The present study sought to characterize and compare the treatment costs for BKP and VP patients through 2 years post-surgery. METHODS: Using the 2005-2009 5% Medicare claims data, BKP and VP patients were identified using ICD-9-CM and CPT-4 codes. Treatment costs (Medicare reimbursement/payment adjusted to June 2011 dollars) were compiled for all components of treatment during the 2-year follow-up. Length of stay (LOS) and treatment costs for BKP and VP patients were compared using logistic regression, adjusting for gender, age, census region, comorbidities (Charlson score), race, socio-economic status (Medicare buy-in status), cancer diagnosis (presence in prior 12 months) and year of surgery. RESULTS: A final cohort of 2878 BKP and 1,609 VP patients was included. LOS was 3.5 ϩ/Ϫ 4.1 days and 5.5 ϩ/Ϫ 4.3 days for BKP and VP patients who had inpatient procedures, corresponding to 43% shorted LOS (adjusted) for BKP (pϽ0.001). There were no significant differences in average adjusted treatment costs for BKP and VP patients within the first 3 (pϭ0.097) and first 6 months (pϭ0.142). For the remaining periods, however, BKP patients had lower adjusted costs (pϽ0.025). At 2 years, the average adjusted costs were 7% lower for BKP (pϭ0.005). CONCLUSIONS: Although BKP and VP patients in the Medicare population were found to have similar treatment costs within the first six months following surgery, BKP was found to be cost saving compared to VP subsequently over time through 2 years.

Enhanced osseous integration of human trabecular allografts following surface modification with bioactive lipids

“…Since vascularization and new bone formation are critical for stable incorporation of massive allografts, for example in large skull flaps commonly transplanted in wounded soldiers, there is a clinical need for new grafting technologies that enhance these endogenous reparative processes. In addition to annual costs of grafting procedures, $120 billion is spent to treat bone injuries that do not necessitate grafts, including 7.9 million annual bone fractures that carry a 10 % incidence of non-union [7], which leads to improper healing and higher risk of re-injury. The development of an off-the-shelf acellular therapy that could meet both graft-based and graft-independent treatment of bone defects is clinically desirable.…”