Evaluation of Cost-Utility of Thoracic Interlaminar Epidural Injections

Manchikanti, Laxmaiah; Pampati, Vidyasagar; Sanapati, Satya P; Sanapati, Mahendra R; Kaye, Alan D.; Hirsch, Joshua A

doi:10.1007/s11916-020-0838-1

Cited by 4 publications

(3 citation statements)

References 72 publications

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“…In addition to quality measures, healthcare utilization is of particular importance in management of spine degenerative disease and much work has been done to characterize the cost-effectiveness of ESI. 10,[24][25][26][27] In a retrospective cohort study, Manchikanti et al 24 demonstrated the cost-utility of cervical ESI in patients refractory to previous conservative management. Alvin and colleagues similarly reported that cervical ESI is more cost-effective than other nonoperative treatment modalities in the short-term.…”

Section: Discussionmentioning

confidence: 99%

Do Epidural Steroid Injections Affect Outcomes and Costs in Cervical Degenerative Disease? A Retrospective MarketScan Database Analysis

Wadhwa

Varshneya

Stienen

et al. 2021

Global Spine Journal

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Study Design Retrospective cohort study. Objective To investigate the effect of preoperative epidural steroid injection (ESI) on quality outcomes and costs in patients undergoing surgery for cervical degenerative disease. Methods We queried the MarketScan database, a national administrative claims dataset, to identify patients who underwent cervical degenerative surgery from 2007 to 2016. Patients under 18 and patients with history of tumor or trauma were excluded. Patients were stratified by ESI use at 3, 6, 12, 18, and 24 or more months preoperative. Propensity score matched controls for these groups were obtained. Baseline demographics, postoperative complications, reoperations, readmissions, and costs were compared via univariate and multivariate analysis. Results 97 117 patients underwent cervical degenerative surgery, of which 29 963 (30.7%) had ESI use at any time preoperatively. Overall, 90-day complication rate was not significantly different between groups. The ESI cohorts had shorter length of stay, but higher 90-day readmission and reoperation rates. ESI use was associated with higher total payments through the 2-year follow-up period. Among patients who received preoperative ESI, male sex, history of cancer, obesity, PVD, rheumatoid arthritis, nonsmokers, cervical myelopathy, BMP use, anterior approach, 90-day complication, 90-day reoperation, and 90-day readmission were independently associated with increased 90-day total cost. Conclusion ESI can offer pain relief in some patients refractory to other conservative management techniques, but those who eventually undergo surgery have greater healthcare resource utilization. Certain characteristics can predispose patients who receive preoperative ESI to incur higher healthcare costs.

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Section: Discussionmentioning

confidence: 99%

Do Epidural Steroid Injections Affect Outcomes and Costs in Cervical Degenerative Disease? A Retrospective MarketScan Database Analysis

Wadhwa

Varshneya

Stienen

et al. 2021

Global Spine Journal

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“…The utilization patterns of interventional techniques overall from 2000 to 2018 showed a decline of all interventional techniques at an annual rate of 0.8% with an overall decline of 6.7% (1). Specifically, epidural procedure utilization has declined at a rate of 20.7% per 100,000 Medicare enrollees from 2009 to 2018, with an annual decline of 2.5%.…”

mentioning

confidence: 99%

“…I I nterventional techniques have been a focus of utilization trends and subsequent increases in costs in recent years, accompanied by the application of multiple regulations and measures to reduce utilization and expenditures (1)(2)(3)(4)(5)(6)(7)(8). One of the measures utilized for these purposes has been the enactment of the Affordable Care Act (ACA) to improve access, quality of care, and to reduce health care costs in the United States (9)(10)(11).…”

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confidence: 99%

January 2021

2020

Pain Phys

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Background: Despite epidurals being one of the most common interventional pain procedures for managing chronic spinal pain in the United States, expenditure analysis lacks assessment in correlation with utilization patterns.Objectives: This investigation was undertaken to assess expenditures for epidural procedures in the feefor-service (FFS) Medicare population from 2009 to 2018.Study Design: The present study was designed to assess expenditures in all settings, for all providers in the FFS Medicare population from 2009 to 2018 in the United States. In this manuscript: • A patient was described as receiving epidural procedures throughout the year.• A visit was considered to include all regions treated during the visit.• An episode was considered as one treatment per region utilizing primary codes only.• Services or procedures were considered as all procedures including bilateral and multiple levels.A standard 5% national sample of the Centers for Medicare and Medicaid Services (CMS) physician outpatient billing claims data for those enrolled in the FFS Medicare program from 2009 to 2018 was utilized. All the expenditures were presented with allowed costs and adjusted to inflation to 2018 US dollars.

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