OBJECTIVES: There has been recent controversy regarding the effectiveness of vertebral augmentation (balloon kyphoplasty (BKP) and vertebroplasty (VP)) for treating vertebral compression fractures (VCFs). Limited cost comparisons of BKP and VP suggest that initial hospital costs are higher for BKP (Mehio 2011), however costs for subsequent post-operative care are unknown. The present study sought to characterize and compare the treatment costs for BKP and VP patients through 2 years post-surgery. METHODS: Using the 2005-2009 5% Medicare claims data, BKP and VP patients were identified using ICD-9-CM and CPT-4 codes. Treatment costs (Medicare reimbursement/payment adjusted to June 2011 dollars) were compiled for all components of treatment during the 2-year follow-up. Length of stay (LOS) and treatment costs for BKP and VP patients were compared using logistic regression, adjusting for gender, age, census region, comorbidities (Charlson score), race, socio-economic status (Medicare buy-in status), cancer diagnosis (presence in prior 12 months) and year of surgery. RESULTS: A final cohort of 2878 BKP and 1,609 VP patients was included. LOS was 3.5 +/- 4.1 days and 5.5 +/- 4.3 days for BKP and VP patients who had inpatient procedures, corresponding to 43% shorted LOS (adjusted) for BKP (p<0.001). There were no significant differences in average adjusted treatment costs for BKP and VP patients within the first 3 (p=0.097) and first 6 months (p=0.142). For the remaining periods, however, BKP patients had lower adjusted costs (p<0.025). At 2 years, the average adjusted costs were 7% lower for BKP (p=0.005). CONCLUSIONS: Although BKP and VP patients in the Medicare population were found to have similar treatment costs within the first six months following surgery, BKP was found to be cost saving compared to VP subsequently over time through 2 years.