Costs for fusion about 50% higher than TDR in patients denied TDR insurance coverage

ORLANDO, Fla. — Billed costs and payments received were higher for lumbar fusions than for a comparable group of patients who underwent lumbar total disc replacement for the same indications, according to a study presented here.

“The total bill was approximately 50% greater for fusion than it was for total disc replacement (TDR), which was statistically significant and the amount of payment received was also about 50% greater for fusion than for TDR,” Donna D. Ohnmeiss, DrMed, said during a health care value in economics session at the 2010 Annual Meeting of the North American Spine Society.

Ohnmeiss said she and her colleagues conducted only the fifth study examining the costs of TDR surgery performed in the United States, but noted that economic issues related to such new technology has become nearly as important a consideration to some groups as its safety and effectiveness.

Matched groups

Donna D. Ohnmeiss

The investigators examined the Texas Back Institute’s surgical log to identify eight patients who met the indications for lumbar TDR but who, during a 9-month period, underwent a one-level or two-level fusion after their insurance carrier denied paying for a TDR. Five patients underwent one-level fusions and three patients underwent two-level fusions.

For the cost analysis, investigators matched each of them with a patient who underwent TDR surgery at the same hospital, for the same indication, at the same level, by a member of the same surgical group, on about the same day. Gender, age, BMI and other demographics were similar between the groups, according to Ohnmeiss.

In both groups, “The approach was done exactly the same with an access surgeon using a retroperitoneal [approach],” she said.

Comparative analysis

The comparative analysis took into account total hospital charges, including billing charge categories, as well as actual payments collected. It revealed that costs for such billing categories as hospital room, pharmacy, durable supplies, operating room services and anesthesia were notably less for TDR surgery. At the same time, the analysis show there was a trend toward costs being less for intravenous supplies, surgery, clamps and related supplies in the TDR group, Ohnmeiss said.

“The payments actually trended toward being less expensive in TDRs than fusion, though it did not quite reach significance,” she said, adding that only intraoperative imaging was a more expensive charge in the TDR group.

Ohnmeiss noted a downside of her study was its small sample size, but said that may have been offset by the groups being nearly ideally matched.

Reference:
Ohnmeiss DD, Hume CS, Blumenthal SL, et al. Cost comparison of total disc replacement vs. fusion in patients with insurance denial for disc replacement. Paper #79. Presented at the 2010 Annual Meeting of the North American Spine Society. Oct. 5-9, 2010. Orlando, Fla.

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