OBJECTIVES: Balloon kyphoplasty (BKP) is a minimally invasive procedure for the treatment of painful vertebral compression fractures (VCFs). Superior clinical outcomes data versus non surgical management (NSM) has recently been demonstrated in a large RCT comparing BKP and VCF. Furthermore, preliminary results of a large retrospective US medicare claim base data analysis have been shown to significantly decrease mortality risk of a VCF patient when treated with BKP compared to NSM. Aim of this study is the evaluation of resource usage and costs for treatment of BKP patients in comparison to NSM patients from a social insurance perspective. METHODS: In this prospective, non-randomised follow-up-study treatment and costs were evaluated in 8 study centers in Germany between 2005 and 2008. Data was recorded by questionnaires at baseline and by phone at follow-up. Resource usage was valued by DRG for inpatient treatment, EBM fur outpatient treatment and Lauer-taxe for medication. RESULTS: The higher initial DRG treatment costs in the BKP arm are partially off-set by lower follow-up costs (Follow-up DRG costs: BKP: €131.08; NSM: €1149.75; Mann-Whitney-U: p=0.006; Outpatient treatment: BKP: €860.57; NSM: €991.65; Mann-Whitney-U: p=0,300; Medication: BKP: €136.56; NSM: €338.42; Mann-Whitney-U: p=0.007). Total costs for the BKP patients were € 3,874.12 higher than for the NSM patients (Mann-Whitney-U: p=0.000). Compared to NSM, BKP treated patients had significantly shorter hospital stay for both the initial and follow-up hospitalization (9.6 versus 14.7, p=0.000 and in follow-up hospitalization 10.7 versus 17.7, p=0.005). CONCLUSIONS: The higher baseline costs of BKP versus NSM are partially off-set by reduced follow-up treatment costs. The remaining additional costs have to be weighted against shorter hospital stay and improved clinical outcomes. Full economic evaluations of BKP versus NSM in the UK, Italy and Spain have already demonstrated the cost-effectiveness of BKP versus NSM.