, Paducah, USA.
Curr Pain Headache Rep. 2020 Apr 14;24(5):22. doi: 10.1007/s11916-020-00850-2.
To review the utilization patterns of vertebral augmentation procedures in the US Medicare population from 2004 to 2017 surrounding concurrent developments in the literature and the enactment of the Affordable Care Act (ACA).
The analysis of vertebroplasty and kyphoplasty utilization patterns was carried out using specialty utilization data from the Centers for Medicare and Medicaid Services Database. Of note, over the period of time between 2009 and 2017, the number of people aged 65 or older showed a 3.2% rate of annual increase, and the number of Medicare beneficiaries increased by 27.6% with a 3.1% rate of annual increase. Concurrently, vertebroplasty utilization decreased 72.8% (annual decline of 15% per 100,000 Medicare beneficiaries), and balloon kyphoplasty utilization decreased 19% (annual decline of 2.6% per 100,000 Medicare beneficiaries). This translates to a 38.3% decrease in vertebroplasty and balloon kyphoplasty utilization (annual decline of 5.9% per 100,000 Medicare beneficiaries) from 2009 to 2017. By contrast, from 2004 to 2009, there was a total 188% increase in vertebroplasty and balloon kyphoplasty utilization (annual increase rate of 23.6% per 100,000 Medicare beneficiaries). The majority of vertebroplasty procedures were done by radiologists, and the majority of kyphoplasties were done by aggregate groups of spine surgeons. These results illustrate a significant decline in vertebral augmentation procedures in the fee-for-service Medicare population between 2004 and 2017, with dramatic decreases following the publication of two 2009 trials that failed to demonstrate benefit of vertebroplasty over sham and the enactment of the ACA.
目的：综述了 2004 年至 2017 年美国医疗保险人群中椎体增强术的应用模式，同时回顾了相关文献的进展和《平价医疗法案》（ACA）的颁布。
发现：使用医疗保险和医疗补助服务中心数据库的专业使用数据对经皮椎体成形术和球囊椎体后凸成形术的使用模式进行了分析。值得注意的是，在 2009 年至 2017 年期间，65 岁或以上的人数以每年 3.2%的速度增长，而医疗保险受益人数增加了 27.6%，每年增长 3.1%。与此同时，经皮椎体成形术的使用率下降了 72.8%（每年每 10 万医疗保险受益人数下降 15%），球囊椎体后凸成形术的使用率下降了 19%（每年每 10 万医疗保险受益人数下降 2.6%）。这意味着从 2009 年到 2017 年，经皮椎体成形术和球囊椎体后凸成形术的使用率下降了 38.3%（每年每 10 万医疗保险受益人数下降 5.9%）。相比之下，从 2004 年到 2009 年，经皮椎体成形术和球囊椎体后凸成形术的总使用率增加了 188%（每年每 10 万医疗保险受益人数增加 23.6%）。大多数经皮椎体成形术是由放射科医生完成的，而大多数球囊椎体后凸成形术是由脊柱外科医生的综合团体完成的。这些结果表明，在 2004 年至 2017 年期间，医疗保险人群中椎体增强术的数量显著下降，在 2009 年的两项试验未能证明经皮椎体成形术优于安慰剂，以及《平价医疗法案》颁布后，该手术数量急剧下降。
