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Utilization of Vertebral Augmentation Procedures in the USA: a Comparative Analysis in Medicare Fee-for-Service Population Pre- and Post-2009 Trials

  • Other Pain (AD Kaye and N Vadivelu, Section Editors)
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Abstract

Purpose of Review

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).

Recent Findings

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.

Summary

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.

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Acknowledgments

The authors wish to thank Bert Fellows, MA, Director Emeritus of Psychological Services, for manuscript review, and Tonie M. Hatton and Diane E. Neihoff, transcriptionists, for their assistance in preparation of this manuscript.

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    Laxmaiah Manchikanti, Jaya Sanapati, Vidyasagar Pampati, Alan D. Kaye & Joshua A. Hirsch

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Conflict of Interest

Laxmaiah Manchikanti has provided limited consulting services to Semnur Pharmaceuticals, Incorporated, which is developing nonparticulate steroids. Jaya Sanapati and Vidyasagar Pampati declare no conflict of interest. Alan Kaye is a Section Editor for Current Headache and Pain Reports. He has not been involved in the editorial handling of this manuscript. Dr. Kaye is also a speaker for Merck. Joshua Hirsch is a consultant for Medtronic and on the DMC for Relievent.

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Manchikanti, L., Sanapati, J., Pampati, V. et al. Utilization of Vertebral Augmentation Procedures in the USA: a Comparative Analysis in Medicare Fee-for-Service Population Pre- and Post-2009 Trials. Curr Pain Headache Rep 24, 22 (2020). https://doi.org/10.1007/s11916-020-00850-2

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