If you’re decision to have spinal fusion is driven by cost, you may want to drive to the Midwest. According to a new study from the University of Utah, the price of such an operation varies by region, with costs being lowest in the Midwest and highest in the Northeast. The research, published in the September 1, 2015 issue of Spine, was conducted by W. Ryan Spiker, M.D. and his colleagues.
Huge Geographic Variations in Cost of Spinal Fusion
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The researchers analyzed 2012 Medicare data as it pertains to anterior cervical discectomy and fusion (ACDF) and posterior lumbar fusion (PLF). As a comparison procedure, the researchers examined the cost of total knee arthroplasty (TKA).
“Each procedure had a significant range in cost across the country, ” Dr. Spiker and co-authors noted in the article. Costs for ACDF ranged from about $11, 000 to $25, 000, while PLF costs ranged from $20, 000 to $37, 000. For TKA patients without major medical conditions, the range was from about $11, 000 to $19, 000.
Co-author Vadim Goz told OTW, “We were surprised by two findings in the study, the first being the degree of variation in costs. The average cost of a single level ACDF ranged from $10, 879 in Alabama to $24, 923 in Maryland. This is a fairly astounding difference. What is even more interesting is that the variation in costs was not explained by a state’s total population and was only partially explained by a state’s cost of living.”
Goz added, “The next step will focus on identifying geographic areas and providers that are able to provide high quality care at a lower cost. We hope to identify cost drivers, and factors that allow for delivery of care for less, and understand what factors result in higher costs for similar procedures in similar patient populations.”
Dr. Spiker commented to OTW, “As the world of healthcare continues to evolve, it is important for orthopaedic surgeons to take a leading role in understanding and controlling the cost of care. It is critical that we understand the issues that impact the cost surgical treatments in order to provide appropriate and cost effective care.”
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This is a fascinating development. In my practice we've seen similar outcomes with the revised protocol. The key differentiator seems to be patient selection criteria. Has anyone else noticed the correlation with BMI thresholds?
Great point. I'd push back slightly on the conclusion, the sample size in the cited study is too small to draw population-level inferences. That said, the directional signal is compelling and worth a larger RCT.
We implemented a similar approach last year. Early results are promising but we're still gathering 12-month follow-up data. Happy to share our protocol if anyone is interested.
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