Presentation Abstract

Session: 811-825-Spine VI
Date/Time: Friday, Mar 22, 2013, 4:00 PM - 4:06 PM
Location McCormick Place, Room S102
Presentation Number: Paper 811
Title: Variations in Costs of Spinal Implants
Classification: +Other (Spine)
Keywords: Instrument / Pedicle Screw; Economic / Cost Analysis; Instrumentation
Author(s): Sohrab Pahlavan, MD, Orange, California
Samuel Bederman, MD, PhD, FRCSC, Orange, California
Abstract: INTRODUCTION: With increasing costs of providing health care in the U.S. and the emergence of healthcare reform, there is a need to control expenditures. Surgical implants account for a significant portion of the direct cost of surgical care, and are an area of potential cost savings. The current model of implant use has surgeons selecting implants, with hospitals paying using non-disclosed pricing sums negotiated with the manufacturers’ representatives, and leads directly to inefficiencies of market. The purpose of this paper is to document significant variability in costs of spinal implants within and between academic medical centers.
METHODS: Hospital purchasing records of a consortium of academic medical centers were obtained. The unit costs, the volume purchased and anonymized vendors for spinal products were obtained from these records. The costs of pedicle screws (PS), anterior cervical plates (ACP) and posterior interbody cages were compared across 46 medical centers and between seven implant vendors to quantify the amount of variability. Use volume was extrapolated to estimate a total annual volume where only part of the year was reported. For each vendor and implant type, the mean cost and cost range were calculated. Bivariate comparisons between implant cost and annual use volume was analyzed with simple linear regression.
RESULTS: From our database we identified 181, 158 and 102 records from 45, 41 and 33 medical centers for PS, ACP and cages, respectively. Across academic medical centers, range of pedicle screw prices was $400-$1,843, with a mean of $878. Mean price of ACP was $1,068 (range $540-2,388). The mean price for cages was $2,975 (range $938-$7,200). From our regression analysis, we found a direct correlation between implant volumes and implant price. For every one more implant used, the unit price was reduced by $0.28 (p = 0.0044), $4.33 (p = 0.0011) and $6.86 (p = 0.0011) for PS, ACP and cages respectively.
CONCLUSION: Significant variations exist in the costs of spinal implants between medical centers. Price ranges varied from a factor of 4.4 to 7.7, including significant variability between academic medical. A significant relationship exists between a lower unit cost of implants and higher volume of use. More transparency in implant costs would reduce wide variation and potentially reduce overall healthcare expenditures. An alignment of surgeon, hospital and provider may lead to significant improvement of variability and overall cost of care.

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