Reduction of direct costs in high-risk lumbar discectomy patients during the 90-day post-operative period through annular closure

Figures & data

Table 1 Estimated costs for each intervention by payer type

	Medicare ($USD)	Commercial ($USD)
Index operation (outpatient)
Medicare – PT x 2 sessions	122.85	93.04
Medicare – MRI	203.84	791.94
Medicare – CT	146.26	140.33
Medicare – injection x 2	132.34	290.66
APC 5114 (Medicare)	5,219.36	7,150.52
Medicare – surgeon	578.63	1,938.61
Total	6,403.28	10,405.10
Recurrence discectomy (outpatient)
Medicare – conservative therapy	892.49	1,621.35
APC 5114 (Medicare)	5,219.36	7,150.52
Medicare – surgeon	578.63	1,938.61
Total	6,596.24	10,710.48
Recurrence discectomy (inpatient)
Medicare – conservative therapy	892.49	1,621.35
Medicare – DRG 519	10,290.00	15,526.14
Medicare – surgeon	578.63	1,938.61
Total	11,666.88	19,086.10
Recurrence with fusion
Medicare – conservative therapy	892.49	1,621.35
Medicare DRG 459/460	30,945.65	49,760.12
Medicare – surgeon	619.60	2,034.79
Total	32,363.50	53,416.26
Epidural hematoma
Medicare – conservative therapy	892.49	1,621.35
Medicare – DRG 920	6,327.00	7,402.00
Medicare – surgeon	424.06	1,279.62
Total	7,549.31	10,302.97
Wound infection
Medicare – conservative therapy	892.49	1,621.35
Medicare – DRG 856	16,948.88	24,177.83
Medicare – surgeon	424.06	1,279.62
Total	18,171.18	27,078.81
Implantation of stimulator
Medicare – conservative therapy	892.49	1,621.35
Medicare – DRG 029	20,946.67	34,262.00
Medicare – surgeon	142.00	492.00
Total	21,886.91	36,375.35
Ancillary costs
MRI CPT-73221	203.84	791.94
CT scan CPT-77217	146.26	140.33
Epidural steroid injection CPT-62311	132.34	290.66
Physical therapy CPT-97530	122.85	93.04
Unscheduled office visit CPT-99215	192.96	305.38
Conservative therapy total	892.49	1,621.35

Abbreviations: APC, ambulatory payment classification; CPT, current procedural terminology; CT, computed tomography; DRG, diagnosis-related group; MRI, magnetic resonance imaging; PT, physical therapy.

Figure 1 Sensitivity analysis of 90-day per-patient cost differences.

Notes: Sensitivity analysis of the differences in 90-day costs between control and ACD-treated patients was conducted by varying the distribution of Commercial payers vs Medicare and the ratio of repeat discectomies performed in an OP vs IP setting. Costs include the index discectomy plus additional direct health care costs during the 90-day follow-up period, but the ACD device cost was not included in this analysis. All costs are represented in US dollars ($).
Abbreviations: ACD, annular closure device; IP, inpatient; OP, outpatient.

Table 2 Summary of 90-day clinical outcomes affecting direct Costs

	ACD	Control	P-value
Reherniation (%)	2.2	6.8	0.01
Post-op complications (%)a	3.3	8.6	0.01
Revision surgery (%)	1.9	5.4	0.03

Note:

a Post-op complications included wound dehiscence, infection, epidural hematoma, or device failure.

Abbreviations: ACD, annular closure device; post-op, post-operative.

Table 3 Summary of 90-day direct cost estimates under varying payer distributions

Repeat discectomy: 60% outpatient, 40% inpatient	Payer distribution (%) Commercial: Medicare	Estimated direct health care costs ($USD)a
		ACD	Control	Difference
	100:0	11,123	12,255	1,132
	80:20	10,257	11,299	1,042
	50:50	8,956	9,865	909
	20:80	7,654	8,430	776
	0:100	6,787	7,474	687

Note:

a Costs include index discectomy plus additional direct health care costs during 90-day follow-up; the ACD device cost was not included in this analysis.

Abbreviation: ACD, annular closure device.