Introduction: Failed back surgery syndrome (FBSS) affects 40% of patients following spine surgery with estimated costs of $20 billion to our health care system. However, the costs of medical and surgical treatment, as well as the impact of patients’ insurance providers on overall costs, are relatively unknown. The aim of this study is to assess the cost differences with different insurance providers for FBSS patients.
Methods: A retrospective longitudinal study was performed using the Truven MarketScan® database to identify patients with a history of FBSS from 2004 to 2012. Patients were grouped into Commercial, Medicaid, or Medicare cohorts based on the patients’ insurance claims. We selected patients who received SCS as cases and matched each to five controls using propensity score matching within the same insurance claim. We collected 1-year prior to SCS-implantation (baseline) as well as 1-,3-, and 5-year post-SCS implantation cost outcomes. Poisson generalized linear mixed model with the log(cost) link was applied to the cost outcomes.
Results: We identified 4,747 FBSS patients (Commercial:n=3,161, Medicaid:n=618, Medicare:n=968) who underwent SCS-implantation and 23,504 matched controls (Commercial:n=15,659, Medicaid:n=3,255, Medicare:n=4,590). Baseline characteristics were similar between the cohorts, with the Medicare patient population being older than the other cohorts. At 1- and 3-years post-SCS implantation, Medicare patients had significantly lower median [IQR] cost of pain encounters, medication costs, and overall total costs than the other cohorts. Similarly, by 5-years post-SCS implantation, Medicare patients had lower cost of pain encounters (Medicaid: $413.6 [$91.6, $2,093.6], Commercial: $2,397.1 [$384.5, $9,660.3], Medicare: $1,298.6 [$219.0, $5,152.7],p<0.0001), pain medication costs (Medicaid: $17,47.5 [$214.0, $15,257.0], Commercial: $22,073.4 [$9,116.0, $43,736.1], Medicare: $24,575.8 [$13,014.3, $41,393.7],p<0.0001), and total overall costs (Medicaid: $41,171.9 [$14,028.7, $94,503.7], Commercial: $67,255.6 [$33,600.2, $123,130.7], Medicare: $64,519.6 [$38,555.2, $118,863.3],p<0.0001).
Conclusions: Our study demonstrates that Medicaid patients with FBSS have a lower average annual cost than patients with Commercial or Medicare insurance providers.
Patient Care: Our research sheds light into cost differences between different insurance providers in patients with FBSS, which will improve patient care as more studies identify unnecessary cost.
Learning Objectives: By the conclusion of this session, participants should be able to:
1) Describe the importance of insurance providers on the overall cost for patients with FBSS.
2) Discuss, in small groups, why there is a difference in overall cost between the different insurance groups.