Pain Management Centers of America, Paducah, KY and Evansville, IN; LSU Health Science Center, New Orleans, LA.
Guthrie Robert Packer Hospital, Sayre, PA.
Pain Physician. 2021 Sep;24(6):401-415.
Despite the high prevalence of vertebral compression fractures (VCFs) associated with refractory pain, deformity, or progressive neurological symptoms, minimally invasive vertebral augmentation procedures, including vertebroplasty and kyphoplasty, have been declining in their relative utilization, along with expenditures.
This investigation was undertaken to assess utilization and expenditures for vertebral augmentation procedures, including vertebroplasty and kyphoplasty, in the fee-for-service (FFS) Medicare population from 2009 to 2018.
The present study was designed to assess utilization and expenditures in all settings, for all providers in the FFS Medicare population from 2009 to 2018 in the United States. In this manuscript:• A patient was described as receiving vertebral augmentation over the course of the year.• An episode was considered as one treatment per region per day utilizing primary codes only. • Services or procedures were considered to be procedures including multiple levels.A standard 5% national sample of the Centers for Medicare and Medicaid Services (CMS) physician outpatient billing claims data for those enrolled in the FFS Medicare program from 2009 to 2018 was utilized. All the expenditures were presented with allowed costs and adjusted for inflation to 2018 US dollars.
In 2009, there were 76,860 episodes of vertebral augmentation with a rate of 168 per 100,000 Medicare population, which declined to 58,760, or 99 per 100,000 population for a total decline of 41%, or an annual rate of decline of 5.7% per 100,000 Medicare population. Vertebroplasty interventions declined more dramatically than kyphoplasty from 2009. Total episodes of vertebroplasty were 27,380 with an annual rate of 60 per 100,000 Medicare population, decreasing to 9,240, or 16 per 100,000 Medicare population, a 66% decline in episodes and a 74% decline in overall rate with an annual decline of 11.4% and 13.9%. In contrast, kyphoplasty interventions were 49,480, for a rate per 100,000 population of 108 in 2009 compared to 49,520 in 2018 with a rate of 83, for a decrease of 23% and 2.9% annual decrease. Evaluation of expenditures showed a net decrease of $30,102,809, or 8%, from $378,758,311 in 2009 to $348,655,502 in 2018. However, inflation-adjusted expenditures decreased overall by 21% and 3% annually from $443,147,324 in 2009 to $345,655,502 in 2018. In addition, inflation-adjusted total expenditures per 100,000 Medicare population decreased from $967,549 to $584,992, for an overall decrease of 40%, or an annual decrease of 5%. Per patient expenditures decreased 2% overall with 0% decrease per year.
Vertebral augmentation procedures were assessed only in the FFS Medicare service population. This excluded over 30% of the Medicare population, which is enrolled in Medicare Advantage plans.
This study shows a significant decline in relative utilization patterns of vertebroplasty and kyphoplasty procedures, along with reductions in overall expenditures. The inflation-adjusted total expenditures of kyphoplasty and vertebroplasty decreased 21% with an annual decline of 3%. The inflation-adjusted expenditures per 100,000 of Medicare population decreased 40% overall and 5% per year. In addition, vertebroplasty has seen substantial declines in utilization and expenditure patterns compared to kyphoplasty procedures, which showed trends of decline.
尽管与难治性疼痛、畸形或进行性神经症状相关的椎体压缩性骨折（VCF）的患病率很高，但微创椎体增强程序，包括椎体成形术和后凸成形术，其相对利用率以及支出都在下降。
本研究旨在评估 2009 年至 2018 年在医疗保险费（FFS）人群中，椎体增强程序（包括椎体成形术和后凸成形术）的利用情况和支出情况。
本研究旨在评估 2009 年至 2018 年期间，美国 FFS 医疗保险人群中所有设置、所有提供者的利用情况和支出情况。在本研究中：
患者在一年中被描述为接受了椎体增强治疗。
一个发作被认为是每天对一个区域进行一次治疗，仅使用主要代码。
服务或程序被认为是包括多个水平的程序。
利用了医疗保险和医疗补助服务中心（CMS）医生门诊计费数据 2009 年至 2018 年的全国 5%标准抽样数据，这些数据来自参加 FFS 医疗保险计划的人群。所有支出均按允许成本列出，并根据 2018 年的美元进行了通胀调整。
2009 年，有 76860 例椎体增强术，每 10 万医疗保险人群中有 168 例，这一比例下降到每 10 万人群中有 99 例，总下降了 41%，即每年每 10 万医疗保险人群中下降 5.7%。椎体成形术的干预比后凸成形术下降得更明显。椎体成形术的总发作次数为 27380 例，每年每 10 万医疗保险人群中有 60 例，下降到 9240 例，即每年每 10 万医疗保险人群中有 16 例，发作次数下降了 66%，总体发生率下降了 74%，每年下降 11.4%和 13.9%。相比之下，后凸成形术的干预次数为 49480 次，每 10 万人口的发生率为 108 次，而 2018 年为 49520 次，发生率为 83 次，下降了 23%，每年下降 2.9%。对支出的评估显示，净支出减少了 30102809 美元，即 8%，从 2009 年的 378758311 美元降至 2018 年的 348655502 美元。然而，经通胀调整后，支出总额从 2009 年的 443147324 美元下降了 21%，每年下降 3%，至 2018 年的 345655502 美元。此外，经通胀调整后，每 10 万医疗保险人群的总支出从 967549 美元降至 584992 美元，总降幅为 40%，即每年下降 5%。每位患者的支出总体下降 2%，每年下降 0%。
仅在医疗保险费服务人群中评估了椎体增强程序。这排除了 30%以上参加医疗保险优势计划的医疗保险人群。
本研究表明，椎体成形术和后凸成形术的相对利用模式显著下降，总体支出也有所减少。经通胀调整后，后凸成形术和椎体成形术的总支出下降了 21%，每年下降 3%。经通胀调整后，每 10 万医疗保险人群的支出下降了 40%，总体下降了 5%。此外，与后凸成形术相比，椎体成形术的利用率和支出模式大幅下降，后凸成形术呈下降趋势。
