Medtronic, Inc, 1221 Crossman Ave, Sunnyvale, CA 94089, USA.
Osteoporos Int. 2013 Feb;24(2):451-8. doi: 10.1007/s00198-012-1965-2. Epub 2012 Mar 16.
The life expectancy of vertebral compression fracture (VCF) patients was evaluated as a function of their treatment. Compared to non-operated patients, the kyphoplasty and vertebroplasty patient cohort had 115% and 44% greater adjusted life expectancy, respectively. Kyphoplasty patients had a 34% greater adjusted life expectancy than vertebroplasty patients.
Balloon kyphoplasty and vertebroplasty are minimally invasive procedures for the treatment of painful VCFs. This comparative effectiveness study characterized the life expectancy of VCF patients as a function of their treatment.
Life expectancy of VCF patients in the 100% U.S. Medicare dataset (2005-2008) was estimated using a parametric Weibull survival model (adjusted for comorbidities), and compared between operated and non-operated patients as well as between kyphoplasty and vertebroplasty patients. A total of 858,978 patients with a newly diagnosed VCF were identified, including 119,253 kyphoplasty patients (13.9%) and 63,693 vertebroplasty patients (7.4%).
Adjusted life expectancy was 85% greater for operated than non-operated patients (p < 0.001; 95% confidence interval: 82-89%). Compared to non-operated patients, the kyphoplasty and vertebroplasty patient cohort had 115% (p < 0.001; 95% confidence interval: 111-119%) and 44% (p < 0.001; 95% confidence interval: 42-47%) greater adjusted life expectancy, respectively. Kyphoplasty patients had a 34% greater adjusted life expectancy than vertebroplasty patients (p < 0.001; 95% confidence interval: 31-36%). Across all gender-age groups, the median life expectancy predicted by the parametric Weibull model was 2.2-7.3 years greater for operated than non-operated patients.
Statistically significant and substantial differences in life expectancy were observed between the treated and non-treated cohorts in the Medicare population. Among the treated cohorts, patients in the vertebroplasty group experienced less of a survival benefit than those who received kyphoplasty. The results will be a useful basis for future cost effectiveness studies of VCF treatments for the Medicare population.
评估了椎体压缩性骨折（VCF）患者的预期寿命，其取决于治疗方法。与未接受治疗的患者相比，接受球囊扩张椎体后凸成形术和椎体成形术治疗的患者的校正预期寿命分别增加了 115%和 44%。球囊扩张椎体后凸成形术患者的校正预期寿命比椎体成形术患者高 34%。
球囊扩张椎体后凸成形术和椎体成形术是治疗疼痛性 VCF 的微创方法。本项比较有效性研究根据治疗方法描述了 VCF 患者的预期寿命。
使用参数 Weibull 生存模型（根据合并症进行调整）估算了 Medicare 全人群数据库（2005-2008 年）中 VCF 患者的预期寿命，并将接受治疗和未接受治疗的患者以及接受球囊扩张椎体后凸成形术和椎体成形术治疗的患者进行了比较。共确定了 858978 例新发 VCF 患者，其中 119253 例患者接受了球囊扩张椎体后凸成形术（13.9%），63693 例患者接受了椎体成形术（7.4%）。
与未接受治疗的患者相比，接受治疗的患者校正预期寿命延长了 85%（p<0.001；95%置信区间：82-89%）。与未接受治疗的患者相比，球囊扩张椎体后凸成形术和椎体成形术组患者的校正预期寿命分别增加了 115%（p<0.001；95%置信区间：111-119%）和 44%（p<0.001；95%置信区间：42-47%）。球囊扩张椎体后凸成形术患者的校正预期寿命比椎体成形术患者高 34%（p<0.001；95%置信区间：31-36%）。在所有性别和年龄组中，与未接受治疗的患者相比，参数 Weibull 模型预测的接受治疗的患者的中位预期寿命延长了 2.2-7.3 年。
在 Medicare 人群中，接受治疗和未接受治疗的患者之间的预期寿命存在显著和实质性差异。在接受治疗的患者中，接受椎体成形术治疗的患者的生存获益小于接受球囊扩张椎体后凸成形术治疗的患者。该结果将为 Medicare 人群中 VCF 治疗的未来成本效益研究提供有用的基础。
