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Number Needed to Treat with Vertebral Augmentation to Save a Life
J A Hirsch1, R V Chandra2,3, N S Carter4,3,5
1From the Neuroendovascular Program (J.A.H.), Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts.
AJNR. American Journal of Neuroradiology
|December 21, 2019
Summary
Vertebral augmentation significantly reduces mortality in vertebral compression fractures, with a low number needed to treat to save a life within five years compared to nonsurgical management.
Area of Science:
- Orthopedics
- Geriatric Medicine
- Health Services Research
Background:
- Randomized controlled trials on vertebral augmentation efficacy for vertebral compression fractures show mixed results.
- Claims-based analyses suggest a mortality benefit for vertebral augmentation in these patients.
- Existing evidence necessitates further investigation into the survival benefits of vertebral augmentation.
Purpose of the Study:
- To calculate the number needed to treat (NNT) to save one life at one and five years post-vertebral augmentation.
- To compare the mortality benefit of vertebral augmentation versus nonsurgical management.
- To analyze survival outcomes in Medicare beneficiaries with vertebral compression fractures.
Main Methods:
- Utilized a 10-year sample of the US Medicare database.
- Identified patients with vertebral compression fractures treated with nonsurgical management, balloon kyphoplasty, or vertebroplasty.
- Calculated the NNT comparing augmentation to nonsurgical management using survival probabilities from year 1 to 5.
Main Results:
- The NNT to save one life at one year ranged from 14.8 (kyphoplasty) to 22.8 (vertebroplasty) compared to nonsurgical management.
- By year five, the NNT improved to 11.9 for kyphoplasty and 23.8 for vertebroplasty.
- Both augmentation methods demonstrated a significant mortality benefit over nonsurgical treatment.
Conclusions:
- Vertebral augmentation confers a substantial mortality benefit over nonsurgical management for vertebral compression fractures.
- The number needed to treat to save a life is low, particularly within the first five years post-procedure.
- Medicare data analysis supports the life-saving potential of vertebral augmentation.
