P89. Patient out of pocket cost burden with elective spine surgery

Abstract

<h3>BACKGROUND CONTEXT</h3> Out-of-pocket (OOP) costs for medical and surgical care can result in substantial financial burden for patients and families. Relatively little is known regarding OOP costs for commercially insured patients receiving spinal fusion surgery. <h3>PURPOSE</h3> The aim of this study is to analyze the trends in OOP costs for common, elective spinal fusion surgeries performed in the hospital inpatient setting. <h3>STUDY DESIGN/SETTING</h3> Retrospective review. <h3>PATIENT SAMPLE</h3> This study utilized an employer-sponsored insurance claims database to analyze billing data of commercially insured patients who underwent elective spinal fusion between 2014 and 2019. Patients who received single-level anterior cervical discectomy and fusion (ACDF) and single-level posterior lumbar fusion (PLF) were identified. <h3>OUTCOME MEASURES</h3> OOP costs associated with the surgical episode and the ratio of OOP costs to total insurer contribution (payments from insurers to providers) were assessed. <h3>METHODS</h3> OOP costs associated with the surgical episode were calculated as the sum of deductible payments, co-payments and co-insurance. Monetary data were adjusted to 2019 dollars. General linear regression, Wilcoxon-Mann-Whitney and Krustal-Wallis tests were utilized for analysis, as appropriate. <h3>RESULTS</h3> In total, 10,225 ACDF and 28,841 PLF patients were analyzed. Most patients in our study sample had preferred provider organization (PPO) insurance plans (ACDF 70.3%, PLF 66.9%). The mean OOP costs for patients, by procedure were: ACDF $3,180 (SD=2,495) and PLF $3,166 (SD=2,529). Total OOP costs increased significantly from 2014 - 2019 for both procedures (p<0.0001). Among the insurance plans examined, patients with high-deductible health plans had the highest OOP costs. The ratio of patient contribution (OOP costs) to total insurer contribution (payments from insurers to providers) was 0.07 for ACDF and 0.04 for PLF. <h3>CONCLUSIONS</h3> Among commercially insured patients who underwent elective spinal fusion, OOP costs increased from 2014 to 2019. The OOP costs for elective spinal fusion represent a substantial and increasing financial burden for patients. <h3>FDA DEVICE/DRUG STATUS</h3> This abstract does not discuss or include any applicable devices or drugs.