Abstract
Abstract INTRODUCTION In 2011, our institution abandoned a multi-vendor strategy of purchasing commodity spinal implants, such as pedicle screws and plates, in favor of a dual-vendor model. In 2015, facing ongoing budgetary constraints, we advanced to a sole supplier of these devices. The objective of this study was to report the savings created by the dual-vendor and single-vendor purchasing of spinal implants, and to assess whether vendor rationalization affected the quality-of-care at our institution. METHODS Patients receiving single-level lumbar interbody fusion (CPT# 22630, 22633) at our institution between January 1, 2008 and July 31, 2017 were identified retrospectively. Patients were excluded if they had a multi-level fusion, prior instrumentation, or anterior fusion. Patients were grouped according to the number of vendors available to our surgeons at the time of the patient's surgery; the 2008 to 2010, 2011 to 2014, and 2015 to 2017 time periods were defined as the multi-vendor (10 vendors), dual-vendor, and single-vendor periods, respectively. Propensity score weighting was performed to control for potential confounding between the patient cohorts. Outcomes were defined as rates of 12-mo revision surgeries and patient-reported outcomes, as measured by EQ-5D/PROMIS-GH utilities. Annual cost savings associated with the dual-vendor and single-vendor periods are also reported. RESULTS A total of 1373 patients were analyzed. Rates of revision surgeries after propensity score weighting were 3.2%, 4.5%, and 3.0% for the multi-vendor (Neff = 177.2), dual-vendor (Neff = 546.6), and single-vendor periods (Neff = 418.2), respectively. Revision surgeries (P < .01) and EQ-5D/PROMIS-GH utilities (P < .01) were statistically equivalent across all three time periods and no association between purchasing and the quality-of-care was observed. The annual cost savings directly attributable to vendor rationalization were 24% and 21% for the dual-vendor and single-vendor periods, respectively. CONCLUSION The dual-vendor and single-vendor procurement of spinal implants resulted in significant cost savings for our institution without evidence of a detrimental impact on the quality-of-care provided.
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