What Are the Costs of Cervical Radiculopathy Prior to Surgical Treatment?

Cameron Barton, MD; Piyush Kalakoti, MD; Nicholas A. Bedard, MD; Nathan R. Hendrickson, MD; Comron Saifi, MD; Andrew J. Pugely, MD

Disclosures

Spine. 2019;44(13):937-942. 

In This Article

Results

Patient Characteristics

Overall, 12,514 patients with cervical radiculopathy with adequate preoperative cost data up to 1-year prior to undergoing ACDF were included. Approximately, 89% patients (n = 11,097) were elderly above 50-years of age and 52% were female (n = 6527). Majority of the patients belonged to the South region (70.6%; n = 8828) followed by the Midwest (19.3%; n = 2418), West (8.6%; n = 1077), and Northeast region (1.53%; n = 191). Over sixth of the patients (61.9%) had cervicalgia (61.9%) followed by brachial neuritis (46.6%), cervical spine intervertebral disc displacement (46.2%), spondylosis (44.0%) and degenerative (42.7%) etiologies, and stenosis (42.3%). An overview of patient characteristics is depicted in Table 1.

Primary Outcome Measure (Incurred Costs in the Year Prior to ACDF)

The cumulative costs accrued in nonoperative and treatment modalities in the year prior to ACDF surgery for all patients with cervical radiculopathy was over $14.3 million ($14,308,777) including outpatient visits, physician fees, ancillary, and laboratory/imaging tests. This translates to an average per-capita nonoperative cost $1143 in the year preceding surgical intervention. Approximately, three-quarter (73.3%) of patients underwent at least one nonoperative treatment, while all patients in the cohort underwent at least one diagnostic test for their underlying radiculopathy.

Cost for Diagnostics

The cumulative costs for diagnostic modalities totalled over $8.9 million ($8,907,794 total across system) in the year prior to ACDF, accounting approximately two-thirds (62.3%) of overall nonoperative costs. This equates to an average per-capita cost of $712. All patients underwent at least one diagnostic procedure comprising of either a cervical spine x-ray, CT scan, MRI, EMG, or NCS in the prior to surgery. Of these, MRI was the most routinely performed diagnostic tests (86.6%) followed by cervical spine x-ray (57.5%) and CT (35.2%). EMG/NCS was noted to be performed in a meager 6.8% patients with cervical radiculopathy (Table 2). In terms of costs, MRI constituting the highest total relative spend ($5.3 million; per-capita: $489; 37.0% of total nonoperative costs) followed by CT ($2.6 million; per-capita: $606; 18.6%), x-rays ($0.54 million; per-capita: $76; 3.8%), and EMG/NCS ($0.39 million; per-capita: $467; 2.8%) (Table 2).

Cost for Nonoperative Treatments

The cumulative costs for nonoperative conservative treatment modalities totaled over $5.4 million ($5,400,983) in the year prior to ACDF, accounting for 37.7% of the total economic burden for nonoperative costs. Majority of patients received prescription narcotic medications (40.6%), followed by injections (24.4%), NSAIDs (18.4%), gabapentin (18.2%), PT (17.8%), bracing (12.8%), and chiropractic services (5.7%). In medications, muscle relaxations (3.4%) and tramadol (10.5%) were the least utilized. In terms of costs, injections comprised the highest relative spend ($3.01 million; per-capita:$988) followed by PT ($1.13 million; per-capita: $510) and medications (narcotics: $0.51 million, per-capita $101; gabapentin: $0.21 million, per-capita $93; NSAIDs: 0.107 million, per-capita $47), bracing ($0.25 million; per-capita:$193) and chiropractic services ($0.137 million; per-capita:$193) (Table 2).

Secondary Outcome Measure

The cost of surgical treatment (ACDF) however, was dramatically higher per patient at an average of $18,142 for the hospital stay, and $4457 in professional payments. These estimates, however, exclude facility fee.

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