Unwarranted regional variation in vertebroplasty and kyphoplasty in Switzerland: A population-based small area variation analysis.

Scheuter, Claudia; Wertli, Maria M; Haynes, Alan G; Panczak, Radoslaw; Chiolero, Arnaud; Perrier, Arnaud; Rodondi, Nicolas; Aujesky, Drahomir (2018). Unwarranted regional variation in vertebroplasty and kyphoplasty in Switzerland: A population-based small area variation analysis. PLoS ONE, 13(12), e0208578. Public Library of Science 10.1371/journal.pone.0208578

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BACKGROUND Percutaneous vertebroplasty (VP) and balloon kyphoplasty (BKP) for treating painful osteoporotic vertebral fractures are controversial. OBJECTIVE We assessed the regional variation in the use of VP/BKP in Switzerland. METHODS We conducted a population-based small area variation analysis using patient discharge data for VP/BKP from all Swiss hospitals and Swiss census data for calendar years 2012/13. We derived hospital service areas (HSAs) by analyzing patient flows, assigning regions from which most residents were discharged to the same VP/BKP specific HSA. We calculated age-/sex-standardized mean VP/BKP-rates and measures of regional variation (extremal quotient [EQ], systematic component of variation [SCV]). We estimated the reduction in variation of VP/BKP rates using negative binomial regression, with adjustment for patient demographic and regional socioeconomic factors (socioeconomic status, urbanization, and language region). We considered the residual, unexplained variation most likely to be unwarranted. RESULTS Overall, 4955 VP/BKPs were performed in Switzerland in 2012/13. The age-/sex-standardized mean VP/BKP rate was 4.6/10,000 persons and ranged from 1.0 to 10.1 across 26 HSAs. The EQ was 10.2 and the SCV 57.6, indicating a large variation across VP/BKP specific HSAs. After adjustment for demographic and socioeconomic factors, the total reduction in variance was 32.2% only, with the larger part of the variation remaining unexplained. CONCLUSIONS We found a 10-fold variation in VP/BKP rates across Swiss VP/BKP specific HSAs. As only one third of the variation was explained by differences in patient demographics and regional socioeconomic factors, VP/BKP in the highest-use areas may, at least partially, represent overtreatment.

Item Type:

Journal Article (Original Article)


04 Faculty of Medicine > Medical Education > Institute of General Practice and Primary Care (BIHAM)
04 Faculty of Medicine > Pre-clinic Human Medicine > CTU Bern
04 Faculty of Medicine > Pre-clinic Human Medicine > Institute of Social and Preventive Medicine
04 Faculty of Medicine > Department of General Internal Medicine (DAIM) > Clinic of General Internal Medicine

UniBE Contributor:

Scheuter, Claudia; Wertli, Maria Monika; Haynes, Alan; Chiolero, Arnaud; Rodondi, Nicolas and Aujesky, Drahomir


600 Technology > 610 Medicine & health
300 Social sciences, sociology & anthropology > 360 Social problems & social services




Public Library of Science




Tanya Karrer

Date Deposited:

18 Dec 2018 10:30

Last Modified:

20 Dec 2018 11:32

Publisher DOI:


PubMed ID:


Additional Information:

Claudia Scheuter and Maria M. Wertli contributed equally to this work.





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