Vertebral Augmentation CAC Voting Results

The voting results are in from the March 20, 2019 Vertebral Augmentation Carrier Advisory Committee (CAC) meeting. View the results below.

Q1. How confident are you that there is adequate published evidence percutaneous vertebroplasty improves health outcomes (symptom status, functional abilities, health related QOL) over nonsurgical management in select cases of osteoporotic vertebral compression fracture?

  • CAC Member Average Score: 4.21
  • CAC Member Respondents: 42
  • Total Attendance Average Score: 4.19
  • Total Respondents: 58

 

Q2. If less than intermediate confidence (< 3) is noted in question #1, how confident are you that each of the following concerns regarding percutaneous vertebroplasty has inadequate evidence?

2a. Efficacy:

  • CAC Member Average Score: 1.50
  • CAC Member Respondents: 2
  • Total Attendance Average Score: 2.20
  • Total Respondents: 5

2b. Safety:

  • CAC Member Average Score: 3.5
  • CAC Member Respondents: 2
  • Total Attendance Average Score: 4.00
  • Total Respondents: 5

 

Q3. If less than intermediate confidence (< 3) is noted in question #1, how confident are you that percutaneous vertebroplasty should only be performed within a clinical trial?

  • CAC Member Average Score: N/A
  • CAC Member Respondents: 0
  • Total Attendance Average Score: 3.33
  • Total Respondents: 3

 

Q4. If less than intermediate confidence (< 3) is noted in question #1, how confident are you that each of the following additional percutaneous vertebroplasty evidence is needed?

4a. Blinded randomized trials:

  • CAC Member Average Score: 4.50
  • CAC Member Respondents: 2
  • Total Attendance Average Score: 4.00
  • Total Respondents: 5

4b. Non-blinded randomized trials:

  • CAC Member Average Score: 4.00
  • CAC Member Respondents: 2
  • Total Attendance Average Score: 2.8
  • Total Respondents: 5

4.c Observational trials:

  • CAC Member Average Score: 1.00
  • CAC Member Respondents: 1
  • Total Attendance Average Score: 1.4
  • Total Respondents: 5

4d. Propensity-adjusted claims-based mortality data:

  • CAC Member Average Score: 3.00
  • CAC Member Respondents: 2
  • Total Attendance Average Score: 2.40
  • Total Respondents: 5

4e. Systematic reviews and meta-analyses:

  • CAC Member Average Score: 2.50
  • CAC Member Respondents: 2
  • Total Attendance Average Score: 1.80
  • Total Respondents: 5

4f. Registries:

  • CAC Member Average Score: 4.00
  • CAC Member Respondents: 2
  • Total Attendance Average Score: 2.80
  • Total Respondents: 5

 

Q5. How confident are you that there is adequate published evidence percutaneous kyphoplasty improves health outcomes (symptom status, functional abilities, health related QOL) over non-surgical management in select cased of osteoporotic vertebral compression fracture?

  • CAC Member Average Score: 4.39
  • CAC Member Respondents: 41
  • Total Attendance Average Score: 4.43
  • Total Respondents: 56

 

Q6. If less than intermediate confidence (<3) is noted in question #5, how confident are you that each of the following concerns regarding percutaneous kyphoplasty has inadequate evidence?

6a. Efficacy:

  • CAC Member Average Score: 3.5
  • CAC Member Respondents: 2
  • Total Attendance Average Score: 2.75
  • Total Respondents: 4

6b. Safety:

  • CAC Member Average Score: 4.00
  • CAC Member Respondents: 2
  • Total Attendance Average Score: 4.00
  • Total Respondents: 4

 

Q7. If less than intermediate confidence (<3) is noted in question #5, how confident are you that percutaneous kyphoplasty should only be performed within a clinical trial?

  • CAC Member Average Score: 5.00
  • CAC Member Respondents: 1
  • Total Attendance Average Score: 4.00
  • Total Respondents: 2

 

Q8. If less than intermediate confidence (<3) is noted in question #5, how confident are you that each of the following additional percutaneous kyphoplasty evidence is needed?

8a. Blinded randomized trials:

  • CAC Member Average Score: 5.00
  • CAC Member Respondents: 1
  • Total Attendance Average Score: 5.00
  • Total Respondents: 4

8b. Non-blinded randomized trials:

  • CAC Member Average Score: 2.00
  • CAC Member Respondents: 1
  • Total Attendance Average Score: 1.75
  • Total Respondents: 4

8c Observational trials:

  • CAC Member Average Score: 1.00
  • CAC Member Respondents: 1
  • Total Attendance Average Score: 1.50
  • Total Respondents: 4

8d. Propensity-adjusted claims-based mortality data:

  • CAC Member Average Score: 1.00
  • CAC Member Respondents: 1
  • Total Attendance Average Score: 2.25
  • Total Respondents: 4

8e. Systematic reviews and meta-analyses:

  • CAC Member Average Score: 1.00
  • CAC Member Respondents: 1
  • Total Attendance Average Score: 2.25
  • Total Respondents: 4

8f. Registries:

  • CAC Member Average Score: 5.00
  • CAC Member Respondents: 1
  • Total Attendance Average Score: 3.25
  • Total Respondents: 4

 

Q9. If at least intermediate confidence (=3) is noted in question #1 or #5, how confident are you that there is sufficient published evidence that use of percutaneous vertebral augmentation (PVA) should be limited to each of the following fracture duration?

9a. Acute (<6 wks.)

  • CAC Member Average Score: 3.90
  • CAC Member Respondents: 30
  • Total Attendance Average Score: 3.33
  • Total Respondents: 42

9b. Subacute (6-12 wks.):

  • CAC Member Average Score: 3.87
  • CAC Member Respondents: 30
  • Total Attendance Average Score: 3.38
  • Total Respondents: 42

9c. Chronic (.12 wks.):

  • CAC Member Average Score: 3.00
  • CAC Member Respondents: 30
  • Total Attendance Average Score: 2.67
  • Total Respondents: 42

9d. Timing is secondary to radiographic features and clinical presentation:

  • CAC Member Average Score: 4.61
  • CAC Member Respondents: 33
  • Total Attendance Average Score: 4.67
  • Total Respondents: 46

 

Q10. If at least intermediate confidence (=3) is noted in question #1 or #5, how confident are you that there is adequate published evidence each of the following nonsurgical management intervals be attempted, without success, before PVA?

10a. 0 days:

  • CAC Member Average Score: 3.03
  • CAC Member Respondents: 30
  • Total Attendance Average Score: 2.93
  • Total Respondents: 43

10b. 1-7 days:

  • CAC Member Average Score: 3.13
  • CAC Member Respondents: 31
  • Total Attendance Average Score: 2.80
  • Total Respondents: 44

10c. 1-3 weeks:

  • CAC Member Average Score: 3.07
  • CAC Member Respondents: 30
  • Total Attendance Average Score: 2.70
  • Total Respondents: 43

10d. 3-6 weeks:

  • CAC Member Average Score: 3.03
  • CAC Member Respondents: 30
  • Total Attendance Average Score: 2.70
  • Total Respondents: 43

10e. >6 weeks:

  • CAC Member Average Score: 2.79
  • CAC Member Respondents: 28
  • Total Attendance Average Score: 2.51
  • Total Respondents: 41

 

Q11. How confident are you that there is adequate published evidence that each of the following nonsurgical managements should be attempted?

11a. Bed Rest:

  • CAC Member Average Score: 2.23
  • CAC Member Respondents: 39
  • Total Attendance Average Score: 2.15
  • Total Respondents: 53

11b. Non-opioid analgesics:

  • CAC Member Average Score: 3.11
  • CAC Member Respondents: 38
  • Total Attendance Average Score: 3.04
  • Total Respondents: 52

11c. Opioid Analgesics:

  • CAC Member Average Score: 2.38
  • CAC Member Respondents: 37
  • Total Attendance Average Score: 2.22
  • Total Respondents: 51

11d. Bracing:

  • CAC Member Average Score: 2.58
  • CAC Member Respondents: 38
  • Total Attendance Average Score: 2.40
  • Total Respondents: 52

11e. Physical Therapy:

  • CAC Member Average Score: 2.19
  • CAC Member Respondents: 37
  • Total Attendance Average Score: 2.08
  • Total Respondents: 51

11f. Periosteal infiltration of local anesthetic on the pedicle:

  • CAC Member Average Score: 2.00
  • CAC Member Respondents: 37
  • Total Attendance Average Score: 1.94
  • Total Respondents: 51

11g. Anti-osteoporosis therapy:

  • CAC Member Average Score: 3.21
  • CAC Member Respondents: 38
  • Total Attendance Average Score: 3.63
  • Total Respondents: 52

 

Q12. How confident are you that there is sufficient published evidence that each of the below is a reliable, valid and meaningful indicator of failed nonsurgical management?

12a. Pain precluding ambulation:

  • CAC Member Average Score: 4.47
  • CAC Member Respondents: 36
  • Total Attendance Average Score: 4.46
  • Total Respondents: 52

12b. Pain precluding physical therapy:

  • CAC Member Average Score: 4.09
  • CAC Member Respondents: 35
  • Total Attendance Average Score: 4.10
  • Total Respondents: 51

12c. Unacceptable side effects from nonsurgical management:

  • CAC Member Average Score: 4.33
  • CAC Member Respondents: 36
  • Total Attendance Average Score: 4.38
  • Total Respondents: 52

12d. Progression of vertebral height loss:

  • CAC Member Average Score: 4.26
  • CAC Member Respondents: 35
  • Total Attendance Average Score: 4.04
  • Total Respondents: 51

12e. Persistence of a least moderate pain (VAS =5):

  • CAC Member Average Score: 4.47
  • CAC Member Respondents: 36
  • Total Attendance Average Score: 4.40
  • Total Respondents: 52

12f. Worsening Kyphosis:

  • CAC Member Average Score: 4.14
  • CAC Member Respondents: 36
  • Total Attendance Average Score: 4.04
  • Total Respondents: 52

 

Q13. How confident are you that each of the below specialists should be involved in the decision to use vertebral augmentation?

13a. Radiologist:

  • CAC Member Average Score: 4.05
  • CAC Member Respondents: 37
  • Total Attendance Average Score: 3.91
  • Total Respondents: 53

13b. Neurologists:

  • CAC Member Average Score: 2.59
  • CAC Member Respondents: 37
  • Total Attendance Average Score: 2.57
  • Total Respondents: 53

13c. Spine Surgeon:

  • CAC Member Average Score: 4.37
  • CAC Member Respondents: 38
  • Total Attendance Average Score: 4.19
  • Total Respondents: 54

13d. Referring Physician:

  • CAC Member Average Score: 3.00
  • CAC Member Respondents: 37
  • Total Attendance Average Score: 3.21
  • Total Respondents: 53

13e. Treating physician only:

  • CAC Member Average Score: 3.59
  • CAC Member Respondents: 37
  • Total Attendance Average Score: 3.64
  • Total Respondents: 53

 

Q14. How confident are you that there is adequate published evidence these conclusions are generalizable to the Medicare patient population?

  • CAC Member Average Score: 4.43
  • CAC Member Respondents: 30
  • Total Attendance Average Score: 4.38
  • Total Respondents: 42

 

Last Updated Apr 03, 2019