Economic impact of improving outcomes of lumbar discectomy.
BACKGROUND
Lumbar discectomy is usually a successful operation with a relatively low cost. Potential adjunctive procedures, such as repairing the anulus fibrosus or nucleus replacements, necessitate a cost-benefit analysis.


OBJECTIVE
This economic analysis was performed to understand the potential value of advanced implantable technologies designed to improve outcomes after discectomy.


METHODS
Using an insurance claims-based database, the economics of less-than-favorable outcomes after lumbar discectomy were studied. Estimates of improved clinical outcomes because of adjunctive surgical procedural items were modeled.


METHODS
Using Current Procedural Terminology (CPT-4) codes and International Classification of Diseases, Clinical Modification procedure codes (ICD-9 CM), all lumbar discectomy patients were identified in a 6-month period from a large, 2002, commercially available claims-based data set representing 3.1 million insured lives.


METHODS
Not applicable.


METHODS
Longitudinal data analysis from 3 years (2002-2004) of the database was performed for evidence of claims after the insured's discectomy (up to 18 months post) as a utilization estimate of surgical and medical treatment resultant of less-than-favorable outcomes. Incidence and cost of secondary operations, medical management, and complications were determined. Using these inputs, an economic model was generated to estimate the effect of improvement in discectomy outcomes.


RESULTS
Of the 494 patients who had a discectomy within a 6-month period, 137 (28%) had subsequent claims that suggested the outcome was less than favorable within 18 months. Patients whose insurance claims included codes for a second operation (n=52 patients with 56 operations; 11%) and patients being medically/nonsurgically managed (n=85, 17%) were studied. Average reimbursed charges incurred (2006 dollars) of repeated discectomy (80% of cases) was $6,907 and for arthrodesis (20% of cases) was $24,375. Average additional medical treatment cost to diagnose or manage poor outcome requiring another surgery was $3,365. Procedure-related complications within 40 days of surgery were evident in 15% of the group; with additional average cost to manage of $3,939.


CONCLUSIONS
Substantial cost associated with poor discectomy outcomes is often overlooked or underappreciated. Surgical technologies that can improve outcomes of discectomy by 50% to 70% thus improving patient quality of life can be overall cost-neutral between $971 and $1,655 additionally per patient.
Sherman
John
J
Twin Cities Orthopedics PA, 7373 France Ave. South, Edina, MN 55435, USA.
Cauthen
Joseph
J
Schoenberg
Doug
D
Burns
Matthew
M
Reaven
Nancy L
NL
Griffith
Steven L
SL
D003362:Cost-Benefit Analysis / Q000191:economics; D017586:Diskectomy / Q000009:adverse effects / Q000191:economics*; D017048:Health Care Costs; D006801:Humans; D007345:Insurance Claim Review / Q000191:economics; D007348:Insurance, Health / Q000191:economics*; D007405:Intervertebral Disc Displacement / Q000191:economics / Q000601:surgery; D008159:Lumbar Vertebrae; D011788:Quality of Life; D012086:Reoperation / Q000191:economics*; D016896:Treatment Outcome