Impact of Insurance Provider on Overall Costs in Failed Back Surgery Syndrome: A Cost Study of 122,827 Patients.
OBJECTIVE
Failed back surgery syndrome (FBSS) affects 40% of patients following spine surgery with estimated costs of $20 billion to the US health care system. The aim of this study was to assess the cost differences across the different insurance providers for FBSS patients.


METHODS
A retrospective longitudinal study was performed using the Truven MarketScan®database to identify FBSS patients from 2001 to 2012. Patients were grouped into Commercial, Medicaid, or Medicare cohorts. We collected one-year prior to FBSS diagnosis (baseline), then at year of spinal cord stimulation (SCS)-implantation and nine-year post-SCS implantation cost outcomes.


RESULTS
We identified 122,827 FBSS patients, with 117,499 patients who did not undergo an SCS-implantation (Commercial: n = 49,075, Medicaid: n = 23,180, Medicare: n = 45,244) and 5328 who did undergo an SCS implantation (Commercial: n = 2279, Medicaid: n = 1003, Medicare: n = 2046). Baseline characteristics were similar between the cohorts, with the Medicare-cohort being significantly older. Over the study period, there were significant differences in overall cost metrics between the cohorts who did not undergo SCS implantation with the Medicaid-cohort had the lowest annual median (interquartile range) total cost (Medicaid: $4530.4 [$1440.6, $11,973.5], Medicare: $7292.0 [$3371.4, $13,989.4], Commercial: $4944.3 [$363.8, $13,294.0], p < 0.0001). However, when comparing the patients who underwent SCS implantation, the commercial-cohort had the lowest annual median (interquartile range) total costs (Medicaid: $4045.6 [$1146.9, $11,533.9], Medicare: $7158.1 [$3160.4, $13,916.6], Commercial: $2098.1 [$0.0, $8919.6], p < 0.0001).


CONCLUSIONS
Our study demonstrates a significant difference in overall costs between various insurance providers in the management of FBSS, with Medicaid-insured patients having lower overall costs compared to Commercial- and Medicare-patients. SCS is cost-effective across all insurance groups (Commercial > Medicaid > Medicare) beginning at two years and continuing through nine-year follow-up. Further studies are necessary to understand the cost differences between these insurance providers, in hopes of reducing unnecessary health care expenditures for patients with FBSS.
Department of Neurosurgery, Duke University Medical Center, Durham, NC, USA.
Aladine A
AA
Elsamadicy
Department of Neurosurgery, Duke University Medical Center, Durham, NC, USA.
Samuel Harrison
http://orcid.org/0000-0002-0171-6516
SH
Farber
Department of Biostatistics, Duke University Medical Center, Durham, NC, USA.
Siyun
S
Yang
Department of Neurosurgery, Duke University Medical Center, Durham, NC, USA.
Syed Mohammed Qasim
SMQ
Hussaini
Department of Neurosurgery, Duke University Medical Center, Durham, NC, USA.
Kelly R
KR
Murphy
Department of Neurosurgery, Duke University Medical Center, Durham, NC, USA.
Amanda
A
Sergesketter
Department of Neurosurgery, Duke University Medical Center, Durham, NC, USA.
Carter M
CM
Suryadevara
Department of Neurosurgery, Duke University Medical Center, Durham, NC, USA.
Promila
P
Pagadala
Department of Neurosurgery, Duke University Medical Center, Durham, NC, USA.
Beth
B
Parente
Department of Biostatistics, Duke University Medical Center, Durham, NC, USA.
Jichun
J
Xie
Department of Neurosurgery, Duke University Medical Center, Durham, NC, USA.
Shivanand P
SP
Lad
D000368:Aged; D003362:Cost-Benefit Analysis / Q000639:trends; D055111:Failed Back Surgery Syndrome / Q000191:economics* / Q000453:epidemiology / Q000628:therapy; D005260:Female; D017048:Health Care Costs / Q000639:trends; D006282:Health Personnel / Q000191:economics / Q000639:trends; D006801:Humans; D007348:Insurance, Health / Q000191:economics* / Q000639:trends; D008137:Longitudinal Studies; D008297:Male; D008484:Medicaid / Q000191:economics / Q000639:trends; D006278:Medicare / Q000191:economics / Q000639:trends; D008875:Middle Aged; D012189:Retrospective Studies; D014481:United States / Q000453:epidemiology
Cost; FBSS; Medicaid; Medicare; SCS; insurance disparities