From the 2024 HVPA National Conference
Wesley Durand MD (Johns Hopkins Hospital), AlekosTh eologis MD (University of California, San Francisco), Miguel Cartagena BS, Gabriel Nazario-Ferrer BS, Richard Skolasky DSc, Hamid Hassanzadeh MD, Khaled Kebaish MD, Paul Sponseller MD, Amit Jain MD, MBA
Background:
Out-of-pocket costs (OOPC) associated with medical and surgical care can cause significant financial burden for patients.
Objective:
We sought to quantify OOPC for surgical treatment of both adolescent and adult spinal deformity in commercially insured patients.
Methods:
This retrospective cohort study utilized a large database of commercial insurance claims. Patients undergoing surgery from 2015 – 2020 for adolescent idiopathic scoliosis (AIS) and adult spinal deformity (ASD) were identified using CPT and ICD-10-CM codes. Patients were stratified into cohorts based on age, with patients 10 – 25 years-old classified as AIS, and patients ≥40 years-old classified as ASD. The surgical care episode was considered from 180 days pre-operative to 30 days post-operatively. The primary outcome variable was OOPC, calculated as the sum of deductibles, copayments, and coinsurance, and adjusted to 2020 dollars.
Results:
2,869 AIS and 1,528 ASD patients who received surgery between 2015 and 2020 were included in the analysis. The median age in years was 15.0 (SD 2.5) for AIS patients, and 58.0 (SD 6.2) for ASD patients. The majority of patients in both cohorts were female (AIS 75.1%, n=2,155; ASD 64.5%, n=986). Of the commercial insurance types, the majority of patients had PPO insurance (AIS 52.4%, n=1,480; ASD 58.0%, n=871), with smaller proportions of CHDP (AIS 13.7%, n=387; ASD 12.2%, n=183), HMO (AIS 11.8%, n=332; ASD 8.7%, n=130), and HDHP (AIS 11.8%, n=332; ASD 8.1%, n=121). OOPC were median 2.6% and 1.8% of total net payments for AIS and ASD surgery, respectively. The median total OOP cost for AIS surgery was $3,231 (SD 2,615) and for ASD surgery was $2,559 (SD 2,803). The total net payments from commercial insurance were $119,493 (SD 71,480) for AIS surgery, and $140,822 (SD 112,060) for ASD surgery. There was significant variation between commercial insurance types, with HDHP plans exhibiting generally the highest OOPC. Total OOPC as well as the total net payments from insurance did not significantly increase from 2015 – 2020 for either AIS or ASD surgery (both p>0.1).
Conclusions:
Total OOPC for commercially insured patients undergoing surgery for AIS and ASD were relatively high. Out-of-pocket costs did not significantly increase over time for either surgery.