Spine J. 2023 Aug 22:S1529-9430(23)03346-6. doi: 10.1016/j.spinee.2023.08.005. Online ahead of print.

ABSTRACT

BACKGROUND CONTEXT: With rising healthcare expenditures in the U.S., patients and providers are searching to maintain quality while reducing cost.

PURPOSE: The aim of this study was to investigate patient willingness to pay for anterior cervical discectomy and fusion (ACDF), degenerative lumbar spinal fusions (LF), and adult spine deformity (ASD) surgery.

STUDY DESIGN/SETTING: A survey was developed and distributed to anonymous respondents through Amazon Mechanical Turk (MTurk).

METHODS: The survey introduced 3 procedures: ACDF, LF, and ASD surgery. Respondents were asked sequentially if they would pay at each increasing price option. Respondents were then presented with various cost-saving methods and asked to select the options that made them most uncomfortable, even if those would save them out-of-pocket costs.

RESULTS: In total, 979 of 1172 total responses (84%) were retained for analysis. Average age was 36.2 years and 44% of participants reported a household income of $50,000-100,000. 63% utilized Medicare and 13% utilized Medicaid. 40% stated they had high levels of financial stress. 30.1% of participants were willing to undergo an ACDF, 30.3% were willing to undergo a LF, and 29.6% were willing to undergo ASD surgery for the cost of $3,000 (p=0.98). Regression demonstrated that for ACDF surgery, a $100 increase in price resulted in a 2.1% decrease in willingness to pay. This is comparable to degenerative LF surgery (1.8% decrease), and ASD surgery (2.0%). When asked which cost-saving measures participants were least comfortable with for ACDF surgery, 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 anaesthesia by a nurse anaesthetist’ (LF: 48.01%, ASD: 55%). Conversely, 36% of ACDF patients were uncomfortable with a “Video/telephone post-operative visit” to cut costs (LF: 51%, ASD: 39%).

CONCLUSION: Patients are unwilling to contribute larger copays for adult spinal deformity correction than for ACDF and degenerative lumbar spine surgery, despite significantly higher procedural costs and case complexity/invasiveness. Patients were most uncomfortable forfeiting newer generation implants, receiving the operation at a community rather than academic center, and receiving care by physician extenders. Conversely, patients were more willing to convert postoperative visits to telehealth and forgo neuromonitoring, indicating a potentially poor understanding of which cost savings measures may be implemented without increasing risk of complications.

PMID:37619868 | DOI:10.1016/j.spinee.2023.08.005