Authors' objectives:

The objective of this health technology assessment (HTA) is to contribute to the work of collecting data for, and preparing a comprehensive assessment of the existing evidence on the use of percutaneous vertebroplasty (PVP). Especially, the intention is to contribute to an analysis and assessment of the economic and organizational consequences of introducing PVP as a mode of treatment that may supplement or replace conservative pain management of patients with osteoporotic vertebral fractures.

PVP technology is gradually gaining a foothold in the Danish health service, and as no randomized clinical trials have yet been conducted, which assess the effect of PVP treatment versus that of conservative treatment, a HTA may help to support any future decision of offering this treatment on a routine basis.

Authors' recommendations: The available literature indicates that PVP is an effective and safe procedure for treating pain caused by osteoporotic vertebral fractures, as 80-90% of the PVP-treated patients report a total or significant pain relief. However, it is a considerable problem that the documentation solely consists of non-randomized clinical trials without control groups with a level of evidence of 3 or less. Criteria for patient inclusion and exclusion in the trials have not been accounted for, and so the patient populations are not well-defined. Thus, we cannot be certain that the populations studied constitute a representative segment of the patient group. In the great majority of cases, patients have not been offered PVP treatment until conservative treatment has proved insufficient, typically weeks after the pain has started. There are no studies available which shed light on the patients short- or long-term functional level, rehabilitation or quality of life following PVP treatment as compared with conservative treatment. The risk of complications when employing PVP is limited to 1-2% within a period of 2-84 months, and these complications predominantly involve cement leakage, which rarely needs to be treated. In this project a model prediction has been made of the socio-economic costs of PVP treatment compared with those of conservative pain management. The cost differential between the two alternatives has been estimated as the difference between the total average costs of a PVP treatment and those of a conservative pain management pathway. The calculations of this study indicate that there is no cost differential between PVP treatment and a conservative pain management pathway. The direct costs of PVP have thus been estimated at DKK 18.455, while the Perkutan vertebroplastik costs of conservative treatment are DKK 17.685 for a period of 6 weeks, starting from the time when the patient can either be referred to PVP or receive continued conservative pain management. However, the figures are subject to a certain degree of uncertainty. Among other things the calculations are sensitive to changes in nursing costs per bed-day in a medical ward, in the duration of hospitalization in connection with conservative treatment, in the costs of materials and in the number of outpatients referred to PVP. Similarly, the need for temporary home care, district nurses, nursing homes, etc., as a result of fractures of the vertebral column has not been included. There are no comparable data on the effect of PVP versus that of conservative pain management in patients with fractures of the vertebral column. Among other things this means that it is not possible to examine the cost-effectiveness of PVP. But with an increased knowledge of the effect of PVP versus that of conservative treatment, it will be possible to conduct a cost-effectiveness analysis.

Authors' methods: Systematic review

Project Status: Completed

URL for project: http://www.sst.dk/publ/Publ2004/perkutan_vertebroplastik.pdf

Year Published: 2004

English language abstract: An English language summary is available

Publication Type: Not Assigned

Country: Denmark

Organisation Name: Danish Centre for Evaluation and Health Technology Assessment

Contact Address: National Board of Health, PO Box 1881, Islands Brygge 67, DK-2300 Copenhagen S, Denmark. Tel: 45 72 22 74 48; Fax: 45 72 22 74 07/67

Contact Name: dacehta@sst.dk

Contact Email: dacehta@sst.dk

Copyright: Danish Centre for Evaluation and Health Technology Assessment (DACEHTA) (formerly DIHTA)