Few patients with newly diagnosed low back pain (LBP) with or without lower extremity pain were found to receive spinal surgery, which represented a large part of healthcare expenditure, according to a study published in JAMA Network Open.

The Truven Health MarketScan Commercial Claims and Encounters and Medicare Supplemental and Coordination of Benefits databases were used to obtain data from opioid-naive patients with LBP with or without lower extremity pain diagnosed between 2008 and 2015 (n=2,498,013; median age, 47 years).

The total cost of care (the study’s primary outcome) within the first 6 months and 12 months after diagnosis was examined and stratified according to occurrence (n=30,624) or absence (n=2,467,389) of spinal surgery.

In this cohort, 1.2% of patients received spinal surgery, which was found to account for 29.3% of healthcare costs over a 12-month period (ie, $784 million), compared with $1.8 billion in total costs for patients who did not undergo spinal surgery.

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After adjusting for age, sex, and comorbidities, per-patient 6-month costs were found to be higher for patients who received vs did not receive spinal surgery ($17,640; 95% CI, $17,604-$17,676 vs $676; 95% CI, $672-$680, respectively; P <.001). Patients who did not undergo surgery were found to receive care that was not in line with clinical guidelines for the management of LBP with or without lower extremity pain. The 12-month adjusted mean costs were greater for patients who received vs did not receive imaging within 30 days of diagnosis ($1194; 95% CI, $1190-$1199 vs $566; 95% CI, $563-$569, respectively; P <.001).

Study limitations include its retrospective design, the lack of individual-level clinical data, and the potential overestimation of guideline nonadherence.

“The cost of imaging itself is the most intuitive explanation for the increased expenditure, although imaging findings may have also indirectly raised the cost by increasing the likelihood of receiving other nonsurgical treatments such as [epidural steroid injection],” concluded the study authors.

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Reference

Kim LH, Vail D, Azad TD, et al. Expenditures and health care utilization among adults with newly diagnosed low back and lower extremity pain. JAMA Netw Open. 2019;2(5):e193676.