Professor Stover Snook taught to his Harvard students that the total health care expenditures for treating back pain the United States was the single greatest health care cost and instrumented cases have grown 6-8% on a yearly basis
Instrumented spine fusion is a expensive endeavor. Even in an high-priced health care system instrumented fusion stands out as an uniquely costly enterprise. This is particularly true because such procedures often engender additional corrective or revision procedures. Multi-level rigid instrumented stabilizations may cost as much as $80-120 thousand and as much as half of the surgical cost can be attributed to instrumentation alone. The typical hospital mark-up on instrumentation (for handling) is usually about 100%.
Rigid fusion instrumentation, particularly pedicle screw instrumentation, is big business. Most spine-related medical meetings today are “feeding frenzies” for pedicle screw manufacturers and the the manufacturers of artificial disc prostheses. Fusion instrumentation for rigid spine stabilization has taken on a life of its own.
Many prominent spine surgeons promoting spinal implants have financial conflicts of interest that patients are not being made aware of. This brings up the question of whose best interest is being served.
To a large extent the cost of fusion is driven by marketing and media hype often eclipsing other, sometimes better, treatment options for surgeons and their patients. As in most medical endeavors the “best buy” is sometimes a lower cost “orphan” technology which doesn’t get much attention. Something else which often also doesn’t get much attention is informed consent which requires the surgeon to disclose to a patient the existence of other surgical options.
The initial, and long-term, costs of multi-level instrumented spine stabilization procedures will always be high. Particularly when surgeons have a conflict of interest in owning their own device company (PODS) and benfiting from a “double dip.” Despite the extensive use of pedicle screw instrumentation for fuaion it is remarkable to note that there is little scientific evidence to support the practice and actually good evidence to contradict it. Fusion as a primary treatment for back pain is unfortunately a prevalent therapy in some communities.
In the attempt to reduce medical device costs some hospital have turned to “preferred” or “privileged” providers. The problems with this are the limiting of physician and surgeon choice of devices, the reduction of price competition and also quite frankly inferior devices being selected on the basis of lower cost alone.
By being better consumers patients and demanding appropriate “informed consent” from their surgeons patients can obtain a better understanding of the non-invasive, minimally invasive as well as surgical options. This represents not only a patient benefit but can also assist in decreasing the overall cost of spine surgery in the health care system.