Clinical Outcomes and Cost-Effectiveness of Demineralized Bone Matrix-Augmented Vertebroplasty for Osteoporotic Vertebral Compression Fractures.

Abstract

Study DesignRetrospective cohort study.ObjectiveTo compare the clinical outcomes and cost-effectiveness of vertebroplasty augmented with demineralized bone matrix (VPDBM) and conventional bone cement vertebroplasty (VPBC) in osteoporotic vertebral compression fractures (OVCFs).MethodsOne hundred eighty-seven patients with acute OVCFs were reviewed (VPDBM, n = 103; VPBC, n = 84). Clinical outcomes were assessed using Visual Analog Scale (VAS) and Koval grade, and radiographic outcomes included vertebral kyphotic angle (VKA), local kyphotic angle (LKA), and correction angle. Treatment failure was defined as refracture requiring hospitalization or reoperation, persistent or worsening pain or function, or radiographic deterioration. Deterioration-free survival (DFS) was analyzed using Kaplan-Meier and Cox regression. Cost-effectiveness was evaluated from the hospital perspective.ResultsBoth groups showed significant postoperative improvement in VAS and Koval grade, without between-group differences at 12 months. Immediate correction angle favored VPBC (<i>P</i> = .041), but this was not sustained. Composite treatment failure was lower with VPDBM (12.6% vs 27.4%), with odds ratio 0.38 (95% CI, 0.18-0.81), risk ratio 0.46 (95% CI, 0.25-0.85), and absolute risk reduction 14.8% (NNT 6.8; <i>P</i> = .010). Kaplan-Meier analysis showed superior DFS in VPDBM (log-rank <i>P</i> = .034). Adjusted Cox regression showed no significant difference (aHR 0.58; 95% CI, 0.24-1.39; <i>P</i> = .222). VPDBM was cost-effective, with ICER ₩43 978 ($32.0) per 1% DFS gain, below common willingness-to-pay thresholds.ConclusionVPDBM reduced treatment failures and improved DFS compared with VPBC, while remaining cost-effective in OVCF management.