Direct medical costs after surgical or nonsurgical treatment for degenerative lumbar spinal disease: A nationwide matched cohort study with a 10-year follow-up

• Authors: Chi Heon Kim, Seoul National University Hospital; Chun K Chung, Seoul National University Hospital; Yunhee Choi, Seoul National University Hospital; Juhee Lee, Seoul National University Hospital; Seung H Yang, Seoul National University Hospital; Chang H Lee, Seoul National University Hospital; Sung Bae Park, Seoul National University Hospital; Kyoung-Tae Kim, Kyungpook Natl Univ Hosp; John Rhee, Emory University; Moon Soo Park, Hallym University
• Journal Title: PLOS ONE
• Volume: Volume 16, Number 12
• Publisher: PUBLIC LIBRARY SCIENCE | 2021-12-01, Pages e0260460-e0260460
• Type of Work: Article | Final Publisher PDF
• Publisher DOI: http://doi.org/10.1371/journal.pone.0260460
• Subjects: Health Sciences, Medicine and Surgery
• Keywords: Science & Technology; Multidisciplinary Sciences; Science & Technology - Other Topics; LOW-BACK-PAIN; RESEARCH TRIAL SPORT; NONOPERATIVE TREATMENT; REOPERATION RATES; DISC HERNIATION; PRACTICE PATTERNS; HEALTH INSURANCE; FUSION SURGERY; OUTCOMES; SPONDYLOLISTHESIS

Abstract

Objective The demand for treating degenerative lumbar spinal disease has been increasing, leading to increased utilization of medical resources. Thus, we need to understand how the budget of insurance is currently used. The objective of the present study is to overview the utilization of the National Health Insurance Service (NHIS) by providing the direct insured cost between patients receiving surgery and patients receiving nonsurgical treatment for degenerative lumbar disease. Methods The NHIS-National Sample Cohort was utilized to select patients with lumbar disc herniation, spinal stenosis, spondylolisthesis or spondylolysis. A matched cohort study design was used to show direct medical costs of surgery (n = 2,698) and nonsurgical (n = 2,698) cohorts. Non-surgical treatment included medication, physiotherapy, injection, and chiropractic. The monthly costs of the surgery cohort and nonsurgical cohort were presented at initial treatment, posttreatment 1, 3, 6, 9, and 12 months and yearly thereafter for 10 years. Results The characteristics and matching factors were well-balanced between the matched cohorts. Overall, surgery cohort spent $50.84/patient/month, while the nonsurgical cohort spent $29.34/patient/month (p<0.01). Initially, surgery treatment led to more charge to NHIS ($2,762) than nonsurgical treatment ($180.4) (p<0.01). Compared with the non-surgical cohort, the surgery cohort charged $33/month more for the first 3 months, charged less at 12 months, and charged approximately the same over the course of 10 years. Conclusion Surgical treatment initially led to more government reimbursement than nonsurgical treatment, but the charges during follow-up period were not different. The results of the present study should be interpreted in light of the costs of medical services, indirect costs, societal cost, quality of life and societal willingness to pay in each country. The monetary figures are implied to be actual economic costs but those in the reimbursement system instead reflect reimbursement charges from the government.