Direct medical costs after surgical or nonsurgical treatment for degenerative lumbar spinal disease: A nationwide matched cohort study with a 10-year follow-up.

Chi Heon Kim,Sung Bae Park,Kyoung-Tae Kim,Seung Heon Yang,Chang Hyun Lee,Yunhee Choi,John M Rhee,Moon Soo Park,Juhee Lee,Chun Kee Chung,Dean Chou

doi:10.1371/journal.pone.0260460

Abstract

The demand for treating degenerative lumbar spinal disease has been increasing, leading to increased utilization of medical resources. Thus, we need to understand how the budget of insurance is currently used. The objective of the present study is to overview the utilization of the National Health Insurance Service (NHIS) by providing the direct insured cost between patients receiving surgery and patients receiving nonsurgical treatment for degenerative lumbar disease. The NHIS-National Sample Cohort was utilized to select patients with lumbar disc herniation, spinal stenosis, spondylolisthesis or spondylolysis. A matched cohort study design was used to show direct medical costs of surgery (n = 2,698) and nonsurgical (n = 2,698) cohorts. Non-surgical treatment included medication, physiotherapy, injection, and chiropractic. The monthly costs of the surgery cohort and nonsurgical cohort were presented at initial treatment, posttreatment 1, 3, 6, 9, and 12 months and yearly thereafter for 10 years. The characteristics and matching factors were well-balanced between the matched cohorts. Overall, surgery cohort spent $50.84/patient/month, while the nonsurgical cohort spent $29.34/patient/month (p<0.01). Initially, surgery treatment led to more charge to NHIS ($2,762) than nonsurgical treatment ($180.4) (p<0.01). Compared with the non-surgical cohort, the surgery cohort charged $33/month more for the first 3 months, charged less at 12 months, and charged approximately the same over the course of 10 years. Surgical treatment initially led to more government reimbursement than nonsurgical treatment, but the charges during follow-up period were not different. The results of the present study should be interpreted in light of the costs of medical services, indirect costs, societal cost, quality of life and societal willingness to pay in each country. The monetary figures are implied to be actual economic costs but those in the reimbursement system instead reflect reimbursement charges from the government.

Highlights

The demand for degenerative spinal disease treatments has been increasing and has led to the increased utilization of medical resources, including surgical treatments and nonsurgical treatments, such as exercise, physical therapy, medication and other interventions [1,2,3]
The authors of the study were approved to use customized tables via virtual terminal connected to personal computer after review of study proposal by Health Insurance Review & Assessment Service (HIRA) for less than 6 months
Any research who had interest in this study can request the use of National Health Insurance Service (NHIS)-NSC by following the procedures outlined at homepage of HIRA

Summary

Introduction

The demand for degenerative spinal disease treatments has been increasing and has led to the increased utilization of medical resources, including surgical treatments and nonsurgical treatments, such as exercise, physical therapy, medication and other interventions [1,2,3]. Many countries have been trying to provide optimal medical services to their residents, but there is an issue of how to utilize limited resources, especially in regard to budgets [4,5,6,7]. A National Health Insurance System (NHIS) is one tool that the government can use to take responsibility in providing medical services to the general population while balancing the efficient use of resources [8, 9]. The objective of the present study was to provide an overview of the utilization of the NHIS for degenerative lumbar spinal disease by reporting the direct medical costs of patients who underwent surgery and of patients who did not undergo surgery

Methods

Results

Conclusion