Wednesday, September 26, 2018 1:00 PM – 2:00 PM Interventional Pain Management: 34. What are the costs of cervical radiculopathy in the year prior to anterior cervical discectomy and fusion?

Cameron Barton; Nicholas A. Bedard; Piyush Kalakoti; Nathan R Hendrickson; Comron Saifi; Andrew J. Pugely

doi:10.1016/j.spinee.2018.06.043

The majority of patients experiencing cervical radiculopathy have symptom resolution within 3 months, but for those failing nonoperative (non-op) management, the gold standard treatment is anterior cervical discectomy and fusion (ACDF). While the costs of operative treatment have been previously described, less is known about the costs of cervical radiculopathy leading up to ACDF. The current study sought to determine the costs associated with nonop management of cervical radiculopathy in the year prior to ACDF. Retrospective, population-based, observational cohort study with longitudinal follow-up. Overall, 12,514 patients with cervical radiculopathy undergoing ACDF were registered with the Humana Inc Claims database between 2007 and 2015. Primary outcome measures included costs for treating patients with cervical radiculopathy a year prior to ACDF surgery. Subgroup analysis on costs for diagnostic tests (X-ray studies, CT, MRI) and nonoperative management (injections, physical therapy, braces, opioids, non-steroidal anti-inflammatories, and tramadol) related to cervical radiculopathy in the year prior to ACDF were calculated. The Humana database was reviewed from 2007 to 2015 for all patients undergoing an ACDF for cervical radiculopathy. Only patients with claims records of at least 1 year prior to ACDF were considered. Myelopathy, trauma, tumor patients were excluded. Costs for diagnostic tests (X-ray studies, CT, MRI) and nonop management (injections, physical therapy, braces, opioids, non-steroidal anti-inflammatories, and tramadol) related to cervical radiculopathy in the year prior to ACDF were calculated. Cost was defined as reimbursement paid by the insurance provider. All costs, except hospital/facility fees, were analyzed relative to the overall costs for cervical radiculopathy. In total, 12,514 cervical radiculopathy patients spent $14,308,777 on nonoperative diagnostic and treatment modalities during the year prior to ACDF ($1,143/patient). All of the patients underwent at least one diagnostic test, and 73.3% underwent nonop treatment. Diagnosistic imaging comprised 47.7% of the total costs and standard nonoperative treatments, 28.9%. MR imaging had the highest total relative spend of 28.4%, and the highest number of patients completing 86.6% (p<.05). A relatively low number of people completed PT, 17.8%, with a relative total cost of 6.1%. Surgical treatment (ACDF) however, was dramatically higher per patient at an average of $18,142 for the hospital stay, and $4,457 in professional payments. In the year prior to ACDF, nearly half of the non-inpatient costs associated with cervical radiculopathy are from diagnostic modalities. Nonoperative diagnostic and treatment costs occurring the year prior to ACDF for cervical radiculopathy average $1,143 per patient. A much smaller amount of the total cost was from nonoperative treatments. With injections removed, only 12.8% of the nonoperative cost was on treatments. MRI held the highest total relative cost of 28.4%, and the highest number of patients completing at 86.6%. ACDF for cervical radiculopathy averaged $18,142 per patient and $4,457 in professional charges. As institutions begin entering into bundled payments for cervical spine disease, understanding condition specific costs is a critical first step. This abstract does not discuss or include any applicable devices or drugs.

Wednesday, September 26, 2018 1:00 PM – 2:00 PM Interventional Pain Management: 34. What are the costs of cervical radiculopathy in the year prior to anterior cervical discectomy and fusion?

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