Prevalence & Economic Burden of Adult Spinal Deformity in a Large United States Commercial Payer Population

Jayme CB Koltsov,1 Stacey J Ackerman,2 Kelly H McFarlane,1 Sanket Mehta,1 Marsalis Brown,3 Michael J Gardner,1 Serena S Hu,1 David W Polly Jr4 1Department of Orthopaedic Surgery, Stanford University School of Medicine, Redwood City, CA, USA; 2Department of Biomedical Engineering, Johns Hopkins University, San Diego, CA, USA; 3Department of Orthopaedic Surgery, MetroHealth Medical Center, Cleveland, OH, USA; 4Department of Orthopedic Surgery, University of Minnesota, Minneapolis, MN, USACorrespondence: Jayme CB Koltsov, Department of Orthopaedic Surgery, Stanford University School of Medicine, 450 Broadway Street Pavilion C, 4th Floor, Mail Code 6342, Redwood, CA, 94063, USA, Email [email protected]: Evaluate the prevalence and economic burden of adult spinal deformity (ASD) in a large, United States (US) commercial payer population.Patients and Methods: Patients aged 21– 64 having an encounter with an ASD diagnosis from the MerativeTM Marketscan® Commercial Databases 2016– 2022 were included to calculate prevalence. The economic burden cohort included those with an outpatient ASD encounter and no spine surgery within the prior year. Continuous health plan enrollment was required for tracking. Expenditures are tabulated from the payer and societal perspectives (2023 US$) and rates of utilization and expenditures are reported overall and by service category.Results: Annual ASD prevalence was 0.50%. 169,855 patients (46± 13 years, 67.7% female) had an outpatient ASD encounter and were included in the economic burden cohort. Total spine-related payer expenditures averaged $7,619 (95% CI; $7,438, $7,800) per patient within 1 year – a payer burden of $3.8 million per 100,000 commercially-insured beneficiaries. Spine-related societal expenditures were $8,759 ($8,570, $8,947) per patient within 1 year – a societal burden of $6.2 billion among the US commercially-insured population. Nonoperative costs comprised 44% of the 1-year payer burden and 48% of the societal burden. While surgical treatment rates were low (3.5% fusions and 2.9% decompressions within 1 year), the associated economic burden was high (55% of payer burden, 51% of societal burden). The 2-year cumulative payer burden totaled $5.4 million per 100,000 commercially-insured beneficiaries, and the US commercially-insured societal burden totaled $8.9 billion.Conclusion: The burden of both operative and nonoperative care for ASD is large. Considerable opportunity exists for development of improved nonoperative treatment modalities to increase the value of ASD care by reducing the need for continued nonoperative interventions of limited benefit and reducing the use of costly surgical interventions.Keywords: adult spinal deformity, healthcare resource utilization, costs, payments, payer perspective, societal perspective, economic burden, fusion