Lightning Podiums: Value and Outcomes in Spinal Surgery - Room 801B

Presented by: S.-R. Golish


V. Bender(1), K. Fitch(2), T. Engel(2), S.R. Golish(3)

(1) Optimize Science, Mill Valley, CA, United States
(2) Milliman, Inc., New York, NY, United States
(3) Jupiter Medical Center, Palm Beach, FL, United States


Background: Lumbar fusion is often performed following decompression in patients with lumbar spinal stenosis (LSS), resulting in significant cost to the healthcare system. Interlaminar stabilization (ILS) is a clinically effective alternative to fusion associated with shorter operative times and a shorter length of hospital stay, both major drivers of cost. We examined the potential economic impact of utilizing ILS instead of fusion for a portion of decompressions requiring stabilization.

Methods: Data regarding the incidence and cost of lumbar decompression and fusion for LSS were gathered from a commercial database (MarketScan 2013, Truven Health Analytics, Ann Arbor, USA). All 2013 costs were trended to 2016 using a 5% annual medical cost trend. We calculated the medical costs including the cost of the initial procedure, 180 day post-surgery recovery and hospitalization, and prescription drugs. In order to estimate the cost of decompression followed by ILS, we added the implant cost to the calculated cost of decompression alone, assuming similar average surgical time, length of stay, and rehabilitation. Using the identified incidence and costs, we then estimated the medical cost impact of replacing 10%, 25%, or 50% of LSS-related spinal fusion surgeries with decompressive surgery followed by an ILS-device (Coflex, Paradigm Spine, New York, USA).

Results: The average cost of LSS-related decompression with fusion was $88,812. The estimated cost of decompression with ILS was $33,776, taking into account the cost of decompressive surgery, implants, hospitalization, and prescription drugs. The estimated difference per procedure between decompression with fusion versus decompression with ILS was $55,037 higher for fusion surgery. The estimated cost savings of replacing 10%, 25%, or 50% of spinal fusions with ILS are $0.15, $0.37, and $0.74 per member per month, respectively. For a commercially insured population of 100,000 members, that would translate to an annual cost savings of $180,000, $444,000 and $888,000, respectively.

Conclusions: Our analysis of the incidence and costs of LSS-related surgery in a commercial insured population estimates that fusion surgery is over $50,000 more costly per procedure than decompression with interlaminar stabilization. Utilization of interlaminar stabilization as an alternative to fusion in a clinically appropriate portion of LSS patients would favorably impact the total cost of care while preserving clinical outcomes.