Australian Government - Department of Health

Medical Services Advisory Committee (MSAC)

27.1 Review of Kyphoplasty for the Treatment of Vertebral Compression Fracture and Review of Interim Funded Service: Vertebroplasty for the Treatment of Vertebral Compression Fracture

Assessment No

27.1
Application NameReview of Kyphoplasty for the Treatment of Vertebral Compression Fracture and Review of Interim Funded Service: Vertebroplasty for the Treatment of Vertebral Compression Fracture
DescriptionVertebroplasty is a minimally invasive procedure used to stabilise fractured vertebrae with the aim of relieving the associated pain. The procedure involves the percutaneous injection, under radiographic guidance (fluoroscopy), of synthetic opacified bone cement into the inter-trabecular marrow space of the fractured vertebral body
Kyphoplasty utilises a bilateral transpedicular approach, under fluoroscopy, to insert a small high pressure balloon catheter into the vertebral body which is then inflated with a liquid, under pressure, to raise the fractured compressed bone and create a cavity. The balloon catheter is then deflated and removed prior to the injection of the synthetic bone cement so as to correct the vertebral deformity.
Advisory PanelProfessor Ken Thomson
(Chair)
(MSAC member)
Dr Kwun Fong
(Deputy )
(MSAC member)
Dr William Clark
(Radiology)
Dr Murali Guduguntla
(Royal Australian and New Zealand College of Radiologists nominee)
Dr Adrian Nowitzke
(Neurological Society of Australasia nominee)
Professor Philip Sambrook
(Australian Rheumatology Association nominee)
Professor Bryant Stokes
(Neurosurgery)
Dr Graeme Brazenor
(RACS nominee and Neurosurgeon Surgeon)
Ms Valerie McKeown
(Consumers' Health Forum of Australia nominee)
Date Received by MSAC Secretariat22/09/2009
Stage 1 - Eligibility22/09/2009
Stage 2 - AssessmentESC Evaluation: 17 March 2011
MSAC Appraisal: 27 - 28 April 2011
Stage 3 - Formulation of Advice to the MinisterReview of Interim Funded Service: Vertebroplasty for the Treatment of Vertebral Compression Fracture

After considering the strength of the available evidence in relation to the safety, effectiveness and cost-effectiveness of percutaneous vertebroplasty for painful vertebral compression fractures, and having noted the dissenting expert opinion, MSAC does not support continued public funding for this procedure.

Review of Kyphoplasty for the Treatment of Vertebral Compression Fracture

After considering the strength of the available evidence in relation to the safety, effectiveness and cost-effectiveness of kyphoplasty for painful vertebral compression fractures, and noting the applicant’s submissions, MSAC does not support public funding for this procedure due to unacceptable cost-effectiveness and uncertainty regarding the extent of additional clinical benefit and consequently the incremental cost-effectiveness ratio over its comparators of conservative treatment or vertebroplasty. MSAC also does not support public funding of kyphoplasty to relieve symptoms associated with functional kyphotic deformity due to a lack of evidence to support its use for this indication.

Stage 4 - Decision
Drs Graeme Brazenor, Murali Guduguntla and William Clark of the 27.1 Advisory Panel did not agree that their views were reflected in the final MSAC Assessment Report:
Review of Kyphoplasty for the Treatment of Vertebral Compression Fracture and Review of Interim Funded Service: Vertebroplasty for the Treatment of Vertebral Compression Fracture
Stage 5 - ImplementationInterm MBS Items 35400 and 35402 for vertebroplasty removed as at 1 November 2011