Major Cost Drivers for Spine Surgery Identified

Peer Reviewed

Researchers have identified the most important cost drivers in spinal surgery as well as considerable variability in both the management and costs of spinal surgery, as reported in the March/April issue of SpineLine.
Money flying in the air"Awareness of costs, and consideration of the incremental value of an added cost empowers the clinician to make more informed decisions regarding value-based care”. Photo Source: “We hope to raise awareness of costs of care, and to promote transparency regarding costs,” said coauthor Sigurd Berven, MD, Professor in Residence, Department of Orthopaedic Surgery, University of California, San Francisco. “Clinicians are often blind to the direct costs of devices, pharmaceuticals, and services in making decisions regarding patient care. Awareness of costs, and consideration of the incremental value of an added cost empowers the clinician to make more informed decisions regarding value-based care,” he said. 

Dr. Berven and his colleague Melissa Esparza, BA, examined data from 532 patients with single level fusions performed at the University of California, San Francisco, between 2008 and 2012. A wide range of direct costs for single-level fusions was found even after excluding extreme outliers from the analysis. Management of comorbidities was a major cause of spending in the highest cost cases. Other important predictors of cost included the surgical approach used, use of implants, and duration of operating room and hospital stay.

“Variability in treatment protocols and approaches is a reflection of the absence of an evidence-based approach to care,” Dr. Berven said. For example, the authors cite differing recommendations in the literature regarding surgical management, surgical approach, instrumentation, and intraoperative services for spinal surgeries.

“Variability of cost within a specific treatment is a reflection of a dysfunctional healthcare economy, compromised by significant disruption of normal market forces including price responsiveness in demand and access to information including cost transparency,” he added.

Findings Advocate for Transparency in Pricing

“I don’t think that understanding the costs alone will directly inform treatment decision making,” commented S. Samuel Bederman, MD, PhD, Spine Surgeon, Assistant Clinical Professor, Director of Orthopaedic Inpatient Services, Department of Orthopaedic Surgery University of California, Irvine. Instead, he believes that research such as Dr. Berven’s study is “advocating for transparency in understanding what is driving costs in spine surgery. Ultimately, knowing those costs will help inform treatment decisions since this becomes another piece of information that you could put into the whole equation to try to figure out what is best for patient care.”

“So, if there is a component of surgery that may be more discretionary and is substantially increasing the price, that may be an opportunity where a provider might say ‘I’m not sure it essential in this case,’ and be more judicious in use,” Dr. Bederman said.

“Effectiveness, techniques, and our knowledge of [spine surgery] has gotten better, but we have been unsuccessful in reducing costs,” Dr. Bederman noted, adding that cost reductions should not be made at the expense of clinical care.

In similar research, Dr. Bederman and Sohrab Pahlavan, MD, recently presented research on prices of materials used in spinal implants across a consortium of academic medical centers. The study showed an up to 8 times difference between the highest and lowest cost of certain products between medical centers. However, further analysis showed that the variability in pricing “is essentially the same as the variation that we see in joint replacement surgeries across medical centers. So while there is variation, it really isn’t out of line with what we see in other areas,” he said.

Dr. Berven and Dr. Bederman are working together on a larger study “to identify similar variability more broadly including across academic medical centers nationally,” Dr. Berven said.

Updated on: 01/06/20
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Sigurd H Berven, MD
Professor Department of Orthopaedic Surgery University of California, San Francisco

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