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Trends in Health Care Expenditures, Utilization, and Health Status Among US Adults With Spine Problems, 1997–2006

Martin, Brook I., MPH*†; Turner, Judith A., PhD‡§; Mirza, Sohail K., MD, MPH; Lee, Michael J., MD; Comstock, Bryan A., MS; Deyo, Richard A., MD, MPH**††

doi: 10.1097/BRS.0b013e3181b1fad1
Health Services Research

Study Design. Analysis of nationally representative survey data for spine-related health care expenditures, utilization and self-reported health status.

Objective. To study trends from 1997 to 2006 in per-user expenditures for spine-related inpatient, outpatient, pharmacy, and emergency services; and to compare these trends to changes in health status.

Summary of Background Data. Although prior work has shown overall spine-related expenditures accounted for $86 billion in 2005, increasing 65% since 1997, the study did not report per-user expenditures. Understanding population-level per-user expenditure for specific services relative to changes in the health status may help assess the value of these services.

Methods. We analyzed data from the Medical Expenditure Panel Survey, a multistage survey sample designed to produce unbiased national estimates of health care utilization and expenditure. Spine-related hospitalizations, outpatient visits, prescription medications and emergency department visits were identified using ICD-9-CM diagnosis codes. Regression analyses controlling for age, sex, comorbidity, and time (years) were used to examine trends from 1997 to 2006 in inflation-adjusted per-user expenditures, and utilization, and self-reported health status.

Results. An average of 1774 respondents with spine problems was surveyed per year; the proportion suggested an increase in the number of people who sought treatment for spine problems in the United States from 14.8 million in 1997 to 21.9 million in 2006. From 1997 to 2006, the mean adjusted per-user expenditures were the largest component of increasing total costs for inpatient hospitalizations, prescription medications, andemergency department visits, increasing 37% (from $13,040 in 1997 to $17,909 in 2006), 139% (from $166 to $397), and 84% (from $81 to $149), respectively. A 49% increase in the number of patients seeking spine-related care (from 12.2 million in 1997 to 18.2 million in 2006) was the largest contributing factor to increased outpatient expenditures. Population measures of mental health and work, social, and physical limitations worsened over time among people with spine problems.

Conclusion. Expenditure increases for spine-related inpatient, prescription, and emergency services were primarily the result of increasing per-user expenditures, while those related to outpatient visits were primarily due to an increase in the number of users of ambulatory services.

We analyzed health care expenditure, utilization, and health status trends from 1997 to 2006 using the Medical Expenditure Panel Survey data from patients with spine problems. National spine-related expenditures increased an average of 7.0% per year, while population measures of perceived mental health and limitations in work, social, and physical functioning worsened. The largest increases in per-user expenditures was related to prescription medications, increasing 10.2% per year.

From the Departments of *Health Services, †Orthopaedics and Sports Medicine, ‡Psychiatry & Behavioral Sciences, and §Rehabilitation Medicine, University of Washington, Seattle, WA; ¶Department of Orthopaedics, Dartmouth-Hitchcock Medical Center, Hanover, NH; ∥Department of Biostatistics, University of Washington, Seattle, WA; and Departments of **Family Medicine and ††Internal Medicine, Oregon Health and Science University, Portland, OR.

Supported by the University of Washington Surgical Dynamics Endowed Chair for Spine Outcomes Research (to B.I.M.).

Acknowledgment date: August 5, 2008. Revision date: February 5, 2009. Acceptance date: February 9, 2009.

The manuscript submitted does not contain information about medical device(s)/drug(s).

Other funds were received in support of this work. No benefits in any form have been or will be received from a commercial party related directly or indirectly to the subject of this manuscript.

The conclusions and opinions presented herein are those of the authors and not necessarily those of the University of Washington, Oregon Health and Science University, or Dartmouth-Hitchcock Medical Center.

Address correspondence and reprint requests to Brook I. Martin, MPH, Department of Orthopaedics and Sports Medicine, Box 359736/PSB5073, 325 Ninth Ave, Seattle, WA 98104; E-mail:

© 2009 Lippincott Williams & Wilkins, Inc.