What would be the annual cost savings if fewer screws were used in adolescent idiopathic scoliosis treatment in the US?

A. Noelle Larson, David W. Polly, Stacey J. Ackerman, Charles G T Ledonio, Baron S. Lonner, Suken A. Shah, John B. Emans, B. Stephens Richards

Research output: Contribution to journalArticle

20 Citations (Scopus)

Abstract

OBJECTIVE: There is substantial heterogeneity in the number of screws used per level fused in adolescent idiopathic scoliosis (AIS) surgery. Assuming equivalent clinical outcomes, the potential cost savings of using fewer pedicle screws were estimated using a medical decision model with sensitivity analysis.

METHODS: Descriptive analyses explored the annual costs for 5710 AIS inpatient stays using discharge data from the 2009 Kids' Inpatient Database (Healthcare Cost and Utilization Project, Agency for Healthcare Research and Quality), which is a national all-payer inpatient database. Patients between 10 and 17 years of age were identified using the ICD-9-CM code for idiopathic scoliosis (737.30). All inpatient stays were assumed to represent 10-level fusions with pedicle screws for AIS. High screw density was defined at 1.8 screws per level fused, and the standard screw density was defined as 1.48 screws per level fused. The surgical return for screw malposition was set at $23,762. A sensitivity analysis was performed by varying the cost per screw ($600-$1000) and the rate of surgical revisions for screw malposition (0.117%-0.483% of screws; 0.8%-4.3% of patients). The reported outcomes include estimated prevented malpositioned screws (set at 5.1%), averted revision surgeries, and annual cost savings in 2009 US dollars, assuming similar clinical outcomes (rates of complications, revision) using a standard- versus high-density pattern.

RESULTS: The total annual costs for 5710 AIS hospital stays was $278 million ($48,900 per patient). Substituting a high for a standard screw density yields 3.2 fewer screws implanted per patient, with 932 malpositioned screws prevented and 21 to 88 revision surgeries for implant malposition averted, and a potential annual cost savings of $11 million to $20 million (4%-7% reduction in the total cost of AIS hospitalizations).

CONCLUSIONS: Reducing the number of screws used in scoliosis surgery could potentially decrease national AIS hospitalization costs by up to 7%, which may improve the safety and efficiency of care. However, such a screw construct must first be proven safe and effective.

Original languageEnglish (US)
Pages (from-to)116-123
Number of pages8
JournalJournal of neurosurgery. Spine
Volume24
Issue number1
DOIs
StatePublished - Jan 1 2016

Fingerprint

Cost Savings
Scoliosis
Inpatients
Costs and Cost Analysis
Reoperation
Therapeutics
Hospitalization
Databases
Health Services Research
International Classification of Diseases
Health Care Costs
Length of Stay
Safety

Keywords

  • AIS = adolescent idiopathic scoliosis
  • curve correction
  • deformity
  • implant density
  • KID = Kids’ Inpatient Database
  • malposition
  • outcomes
  • scoliosis
  • screw

ASJC Scopus subject areas

  • Medicine(all)

Cite this

Larson, A. N., Polly, D. W., Ackerman, S. J., Ledonio, C. G. T., Lonner, B. S., Shah, S. A., ... Richards, B. S. (2016). What would be the annual cost savings if fewer screws were used in adolescent idiopathic scoliosis treatment in the US? Journal of neurosurgery. Spine, 24(1), 116-123. https://doi.org/10.3171/2015.4.SPINE131119

What would be the annual cost savings if fewer screws were used in adolescent idiopathic scoliosis treatment in the US? / Larson, A. Noelle; Polly, David W.; Ackerman, Stacey J.; Ledonio, Charles G T; Lonner, Baron S.; Shah, Suken A.; Emans, John B.; Richards, B. Stephens.

In: Journal of neurosurgery. Spine, Vol. 24, No. 1, 01.01.2016, p. 116-123.

Research output: Contribution to journalArticle

Larson, AN, Polly, DW, Ackerman, SJ, Ledonio, CGT, Lonner, BS, Shah, SA, Emans, JB & Richards, BS 2016, 'What would be the annual cost savings if fewer screws were used in adolescent idiopathic scoliosis treatment in the US?', Journal of neurosurgery. Spine, vol. 24, no. 1, pp. 116-123. https://doi.org/10.3171/2015.4.SPINE131119
Larson, A. Noelle ; Polly, David W. ; Ackerman, Stacey J. ; Ledonio, Charles G T ; Lonner, Baron S. ; Shah, Suken A. ; Emans, John B. ; Richards, B. Stephens. / What would be the annual cost savings if fewer screws were used in adolescent idiopathic scoliosis treatment in the US?. In: Journal of neurosurgery. Spine. 2016 ; Vol. 24, No. 1. pp. 116-123.
@article{4e75c943735041539e67320647ba444e,
title = "What would be the annual cost savings if fewer screws were used in adolescent idiopathic scoliosis treatment in the US?",
abstract = "OBJECTIVE: There is substantial heterogeneity in the number of screws used per level fused in adolescent idiopathic scoliosis (AIS) surgery. Assuming equivalent clinical outcomes, the potential cost savings of using fewer pedicle screws were estimated using a medical decision model with sensitivity analysis.METHODS: Descriptive analyses explored the annual costs for 5710 AIS inpatient stays using discharge data from the 2009 Kids' Inpatient Database (Healthcare Cost and Utilization Project, Agency for Healthcare Research and Quality), which is a national all-payer inpatient database. Patients between 10 and 17 years of age were identified using the ICD-9-CM code for idiopathic scoliosis (737.30). All inpatient stays were assumed to represent 10-level fusions with pedicle screws for AIS. High screw density was defined at 1.8 screws per level fused, and the standard screw density was defined as 1.48 screws per level fused. The surgical return for screw malposition was set at $23,762. A sensitivity analysis was performed by varying the cost per screw ($600-$1000) and the rate of surgical revisions for screw malposition (0.117{\%}-0.483{\%} of screws; 0.8{\%}-4.3{\%} of patients). The reported outcomes include estimated prevented malpositioned screws (set at 5.1{\%}), averted revision surgeries, and annual cost savings in 2009 US dollars, assuming similar clinical outcomes (rates of complications, revision) using a standard- versus high-density pattern.RESULTS: The total annual costs for 5710 AIS hospital stays was $278 million ($48,900 per patient). Substituting a high for a standard screw density yields 3.2 fewer screws implanted per patient, with 932 malpositioned screws prevented and 21 to 88 revision surgeries for implant malposition averted, and a potential annual cost savings of $11 million to $20 million (4{\%}-7{\%} reduction in the total cost of AIS hospitalizations).CONCLUSIONS: Reducing the number of screws used in scoliosis surgery could potentially decrease national AIS hospitalization costs by up to 7{\%}, which may improve the safety and efficiency of care. However, such a screw construct must first be proven safe and effective.",
keywords = "AIS = adolescent idiopathic scoliosis, curve correction, deformity, implant density, KID = Kids’ Inpatient Database, malposition, outcomes, scoliosis, screw",
author = "Larson, {A. Noelle} and Polly, {David W.} and Ackerman, {Stacey J.} and Ledonio, {Charles G T} and Lonner, {Baron S.} and Shah, {Suken A.} and Emans, {John B.} and Richards, {B. Stephens}",
year = "2016",
month = "1",
day = "1",
doi = "10.3171/2015.4.SPINE131119",
language = "English (US)",
volume = "24",
pages = "116--123",
journal = "Journal of Neurosurgery: Spine",
issn = "1547-5654",
publisher = "American Association of Neurological Surgeons",
number = "1",

}

TY - JOUR

T1 - What would be the annual cost savings if fewer screws were used in adolescent idiopathic scoliosis treatment in the US?

AU - Larson, A. Noelle

AU - Polly, David W.

AU - Ackerman, Stacey J.

AU - Ledonio, Charles G T

AU - Lonner, Baron S.

AU - Shah, Suken A.

AU - Emans, John B.

AU - Richards, B. Stephens

PY - 2016/1/1

Y1 - 2016/1/1

N2 - OBJECTIVE: There is substantial heterogeneity in the number of screws used per level fused in adolescent idiopathic scoliosis (AIS) surgery. Assuming equivalent clinical outcomes, the potential cost savings of using fewer pedicle screws were estimated using a medical decision model with sensitivity analysis.METHODS: Descriptive analyses explored the annual costs for 5710 AIS inpatient stays using discharge data from the 2009 Kids' Inpatient Database (Healthcare Cost and Utilization Project, Agency for Healthcare Research and Quality), which is a national all-payer inpatient database. Patients between 10 and 17 years of age were identified using the ICD-9-CM code for idiopathic scoliosis (737.30). All inpatient stays were assumed to represent 10-level fusions with pedicle screws for AIS. High screw density was defined at 1.8 screws per level fused, and the standard screw density was defined as 1.48 screws per level fused. The surgical return for screw malposition was set at $23,762. A sensitivity analysis was performed by varying the cost per screw ($600-$1000) and the rate of surgical revisions for screw malposition (0.117%-0.483% of screws; 0.8%-4.3% of patients). The reported outcomes include estimated prevented malpositioned screws (set at 5.1%), averted revision surgeries, and annual cost savings in 2009 US dollars, assuming similar clinical outcomes (rates of complications, revision) using a standard- versus high-density pattern.RESULTS: The total annual costs for 5710 AIS hospital stays was $278 million ($48,900 per patient). Substituting a high for a standard screw density yields 3.2 fewer screws implanted per patient, with 932 malpositioned screws prevented and 21 to 88 revision surgeries for implant malposition averted, and a potential annual cost savings of $11 million to $20 million (4%-7% reduction in the total cost of AIS hospitalizations).CONCLUSIONS: Reducing the number of screws used in scoliosis surgery could potentially decrease national AIS hospitalization costs by up to 7%, which may improve the safety and efficiency of care. However, such a screw construct must first be proven safe and effective.

AB - OBJECTIVE: There is substantial heterogeneity in the number of screws used per level fused in adolescent idiopathic scoliosis (AIS) surgery. Assuming equivalent clinical outcomes, the potential cost savings of using fewer pedicle screws were estimated using a medical decision model with sensitivity analysis.METHODS: Descriptive analyses explored the annual costs for 5710 AIS inpatient stays using discharge data from the 2009 Kids' Inpatient Database (Healthcare Cost and Utilization Project, Agency for Healthcare Research and Quality), which is a national all-payer inpatient database. Patients between 10 and 17 years of age were identified using the ICD-9-CM code for idiopathic scoliosis (737.30). All inpatient stays were assumed to represent 10-level fusions with pedicle screws for AIS. High screw density was defined at 1.8 screws per level fused, and the standard screw density was defined as 1.48 screws per level fused. The surgical return for screw malposition was set at $23,762. A sensitivity analysis was performed by varying the cost per screw ($600-$1000) and the rate of surgical revisions for screw malposition (0.117%-0.483% of screws; 0.8%-4.3% of patients). The reported outcomes include estimated prevented malpositioned screws (set at 5.1%), averted revision surgeries, and annual cost savings in 2009 US dollars, assuming similar clinical outcomes (rates of complications, revision) using a standard- versus high-density pattern.RESULTS: The total annual costs for 5710 AIS hospital stays was $278 million ($48,900 per patient). Substituting a high for a standard screw density yields 3.2 fewer screws implanted per patient, with 932 malpositioned screws prevented and 21 to 88 revision surgeries for implant malposition averted, and a potential annual cost savings of $11 million to $20 million (4%-7% reduction in the total cost of AIS hospitalizations).CONCLUSIONS: Reducing the number of screws used in scoliosis surgery could potentially decrease national AIS hospitalization costs by up to 7%, which may improve the safety and efficiency of care. However, such a screw construct must first be proven safe and effective.

KW - AIS = adolescent idiopathic scoliosis

KW - curve correction

KW - deformity

KW - implant density

KW - KID = Kids’ Inpatient Database

KW - malposition

KW - outcomes

KW - scoliosis

KW - screw

UR - http://www.scopus.com/inward/record.url?scp=84974809136&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=84974809136&partnerID=8YFLogxK

U2 - 10.3171/2015.4.SPINE131119

DO - 10.3171/2015.4.SPINE131119

M3 - Article

VL - 24

SP - 116

EP - 123

JO - Journal of Neurosurgery: Spine

JF - Journal of Neurosurgery: Spine

SN - 1547-5654

IS - 1

ER -