How Price Sensitive Are Spine Patients?

When patients present for spine surgery, they have typically endured weeks if not months of serious pain, tingling and/or numbness. The decision to have surgery is not entered into lightly.

What role, large or small, does the cost of surgery play in their decision to have surgery?

Researchers from Brown University have completed the first large study which attempts to tease out answers to that interesting question. For the study, Brown’s research team asked patients how much they might be willing to pay for various procedures at various price points.

Their work, “How much are patients willing to pay for spine surgery? An evaluation of attitudes toward out-of-pocket expenses and cost-reducing measures,” appears in the December 2023 edition of The Spine Journal.

The survey, which generated 979 responses, asked patients about the costs of anterior cervical discectomy and fusion (ACDF), degenerative lumbar spinal fusions (LF), and adult spine deformity (ASD) surgery.

Co-author Alan Daniels, M.D., associate professor of orthopedics and spine surgery at Brown, told OTW, “This survey was inspired by an excellent paper by Wahl EP et al that appeared in The Journal of Bone and Joint Surgery: ‘Patient Perspectives on the Cost of Hand Surgery’. We were curious how spine surgery patients would match up with patient perspectives regarding the cost of hand surgery. We chose three very different spinal procedures to see how patient perspectives differ based on surgical invasiveness and risk.”

The average age of respondents was 36.2 years, with 44% of participants reporting a household income of $50,000 to 100,000. A total of 63% had Medicare and 13% had Medicaid; 40% stated they had high levels of financial stress.

Patients were asked, if they had to pay $3,000, would they still be willing to undergo a spine surgery? The survey found that 30.1% of participants were willing to undergo an ACDF, 30.3% were willing to undergo a degenerative LF, and 29.6% were willing to undergo ASD.

Interestingly, the researchers found that for ACDF, a $100 increase in price resulted in a 2.1% decrease in willingness to pay; for degenerative LF surgery it was a 1.8% decrease, while for ASD surgery it was 2%.

Cost Savings Data

When patients were asked which measures they were least comfortable with for ACDF:

• 60% stated “Use of the older generation implants/devices” (LF: 51%, ASD: 60%),
• 61% stated “Having the surgery performed at a community hospital instead of at a major academic center” (LF: 49%, ASD: 56%), and
• 55% stated “Administration of anesthesia by a nurse anesthetist” (LF: 48.01%, ASD: 55%).

Conversely, 36% of ACDF patients were uncomfortable with a “Video/telephone postoperative visit” to cut costs (LF: 51%, ASD: 39%).

Patients Want the Latest Technologies, Regardless…

“Patients were not comfortable forfeiting the latest implants—even though spinal implants from the last decade work exceptionally well!” stated Dr. Daniels.

“Patients may not understand that the most modern implants may actually have higher risk of failure as they are not tried and true tested with long term safety. There have been products lauded as the latest and greatest implants which were launched and failed such as ACDF plates with failing locking mechanisms and expandable cages which collapse over time. The latest implants are not always the greatest!”

And Think Community Hospitals Don’t Have the Latest Technologies…

“Furthermore, patients were not comfortable undergoing surgery in community hospitals and receiving care by physician extenders. Patients should be educated that community hospitals, especially ones with spine centers, can provide excellent care in spine surgery and may actually be better places to go for routine spinal surgery compared to major academic centers. Physician extenders are an essential part of almost all surgical teams, and often are able to spend more time with patients compared to busy surgeons.”

“Finally, patients wishing to save money felt that they were willing to convert postoperative visits to telehealth and forgo neuromonitoring. Spinal deformity patients must get X-rays postoperatively to monitor for devastating complications which can lead to paralysis such as proximal junctional failure, and neuromonitoring is essential for patient safety in many spinal surgery types. Forgoing these essential steps places them at risk of catastrophic complications.”

“Spine surgery patients have a poor understanding of which cost saving measures may impact their safety and surgical outcome. We need education, education, and more education. Patients must be educated regarding spine surgical risks and which components of care are essential for an optimal outcome.”