Evaluating the Potential Cost-Effectiveness of Prophylactic Vertebroplasty for High-Risk Vertebral Compression Fractures Following Spine Stereotactic Radiotherapy in Metastatic Disease

Summary: Vertebral compression fracture (VCF) is a common complication following spinal stereotactic body radiotherapy (SBRT), adversely affecting patient quality of life and increasing healthcare expenditures. These expenses may include costs related to pain management, emergency department visits, hospital admissions, and, in severe cases, surgical interventions such as laminectomy and instrumented fusion for spinal cord compression. This study aims to evaluate the financial impact of VCFs and explore the potential cost-effectiveness of prophylactic vertebroplasty in high-risk patients as identified by our nomogram. This retrospective cohort study, including demographic and treatment data from patients who underwent spinal SBRT between 2013 and 2020. Patients were categorized into high-, intermediate-, and low-risk groups based on our VCF nomogram. We examined VCF-related events, such as ED visits, hospitalizations, and surgical interventions. Patients with uncontrolled back pain requiring pain medications were excluded if they were already receiving these medications for other conditions. This study included 173 patients, with 30 (17%) developing VCF at a median time of 4.4 months. The 1-year cumulative incidence of VCF varied significantly across subgroups. Primary cancers of non-small cell lung cancer (NSCLC), breast, and ano-colorectal origins had a notably higher VCF incidence (27%) compared to other types (12%) (p 7 had a higher VCF incidence (32%) compared to those with a score ≤ 7 (4%) (p < 0.001). Bilsky grade 1 lesions showed a higher incidence of VCF (28%) versus grade 0 (11%) (p = 0.001), and endplate (EP) disruption was strongly associated with increased VCF incidence (31% vs. 5%, p < 0.001). UVA revealed that chronic steroid use, higher SINS score, Bilsky grade 1, EP disruption, adverse pathology, and circumferential treatment were linked to increased VCF risk. MVA confirmed chronic steroid use (HR 2.91, p = 0.04), higher SINS score (HR 1.31, p = 0.005), EP disruption (HR 3.42, p = 0.016), and adverse pathology (HR 2.81, p = 0.007) as significant independent predictors. Patients were classified as low-risk (0-1 points; 105 patients), intermediate-risk (2 points; 47 patients), and high-risk (3-4 points; 21 patients). VCF occurred in 62% of high-risk, 30% of intermediate-risk, and 3% of low-risk patients. Healthcare costs associated with VCF were estimated between $915,500 and $1,710,500, with high-risk group costs averaging $21,071 to $42,738 per patient. Prophylactic vertebroplasty for high-risk patients could reduce costs to $210,000–$315,000 in total, translating to $10,000–$15,000 per patient. High-risk patients with vertebral compression fractures (VCFs) incur substantial healthcare costs and complications. Prophylactic vertebroplasty could be a cost-saving intervention by preventing severe VCF-related events, thereby reducing the financial burden and potentially improving patient outcomes. Khaled Dibs (he/him/his), MD (Presenting Author) - The Ohio State University; Eugene Yap (he/him/his), MD (Co-Author) - The Ohio State University; Ahmed Elguindy (he/him/his), MD (Co-Author) - The Ohio State University; Joshua D.. Palmer, MD (Co-Author) - Department of Radiation Oncology, The James Cancer Hospital and Solove Research Institute at The Ohio State University Wexner Medical Center; Evan Thomas (he/him/his), MD, PhD (Co-Author) - The Ohio State University; Raju Raval (he/him/his), MD, DPhil (Co-Author) - The Ohio State University; Sasha Beyer (she/her/hers), MD, PhD (Co-Author) - The Ohio State University; Emile Gogineni (he/him/his), DO (Co-Author) - The Ohio State University; Vikram Chakravarthy, MD (Co-Author) - The Ohio State University; Brad Elder (he/him/his), MD (Co-Author) - The Ohio State University; Daniel Boulter (he/him/his), MD (Co-Author) - The Ohio State University; Russell Lonser (he/him/his), MD (Co-Author) - The Ohio State University; Arnab Chakravarti (he/him/his), MD (Co-Author) - The Ohio State University; Eric Bourekas, MD (Co-Author) - The Ohio State University; Dukagjin Blakaj (he/him/his), MD, PhD (Co-Author) - The Ohio State University