INTRODUCTION: New technology must not only be evaluated for outcome but also cost. For total disc replacement (TDR) some comparisons have been made within the confines of rigorous trial protocols, but not with well‐matched cohorts outside of a study setting more representative of typical practice. The purpose of this study was to compare hospital costs of TDR to fusion in patients not enrolled in device trials, whose insurance denied payment for TDR.
METHODS: Eight patients were identified for whom TDR was recommended, but were denied insurance coverage for it and subsequently underwent fusion. Hospital costs were compared to 8 TDR patients matched to 8 fusion patients based on level(s) operated (exact match), date of surgery (< 25 days between matched procedures), and all at performed at the same hospital. Both groups had five single‐level cases and three two‐level cases. Seven fusions were combined anterior/posterior procedures. Cost data included total billed and total actually received. Costs were further subclassified and compared by category.
RESULTS: The mean total amount billed for fusion was $98,968.13 vs. $66,349.25 for TDR (p<0.01). The mean total paid for fusion was $54,579.13 vs. $37,123.75 for TDR (0.05<p<0.08). Costs were similar for nonsterile supplies and recovery room. The only cost significantly greater for TDR was radiology services ($612.00 vs. $375.50). Hospital room, pharmacy, sterile supplies, operating room, and anesthesia costs were significantly greater for fusion (p<0.05). There was a trend for greater costs with fusion for intravenous supplies and implants and related supplies (0.05<p<0.075).
DISCUSSION: Although this study had a small sample, denial of TDR and patients electing fusion provided an opportunity to evaluate unusually well matched comparative groups with surgery for same indication, same level(s), same time frame, and same hospital. Both the total amount billed and amount actually paid for fusion were approximately 50% greater than TDR.