番茄社区

CHICAGO -- Wide variations exist in the cost of the screws, plates, and cages for spinal implants, which contributes to the escalating costs of surgery and healthcare overall, a researcher said here.

Currently, hospitals and manufacturers negotiate the price, but individual hospitals are not permitted to share what they've agreed on with other centers, reported Samuel Bederman, MD, PhD, and Sohrab Pahlavan, MD, both of the University of California Irvine.

"One hospital can't just call up another and ask what they are paying for a specific type of implant in the hope of getting the same price," Bederman said.

Surgeons too are unaware of the costs, and usually choose the specific product according to preference, Bederman explained in a press briefing at the annual meeting of the American Academy of Orthopaedic Surgeons.

With the goal of determining the degree of variation in the costs of three specific types of spinal implants -- pedicle screws, anterior cervical plates, and posterior interbody cages -- Bederman's group examined hospital purchasing records for a large consortium of academic medical centers across the country.

A total of 181 records were available from 45 centers for pedicle screws, 158 records from 41 centers for cervical plates, and 102 from 33 centers for the interbody cages.

The mean price of a pedicle screw was $878, while the range was $400 to $1,843, Bederman reported.

For anterior cervical plates, the mean price per item was $1,068, with a range of $540 to $2,388.

And for the interbody cages, where the mean was $2,975, there was an almost eight-fold variation in cost for the very same type of device, with ranges from $938 to $7,200.

In a regression analysis, he identified a correlation between the price of implants and the volume purchased by the hospital.

For each additional implant used, the decreases in price were:

• Pedicle screw: $0.28 (P=0.0044)
• Anterior cervical plates: $4.33 (P=0.0011)
• Interbody cages: $6.86 (P=0.0011)

It wasn't a tremendous reduction in price, however, and the correlation wasn't perfect. Some low-volume centers had low costs, he noted.

With current cost containment trends, the sustainability of prices for these implants is unclear.

"But what is needed today is more transparency in the system," Bederman said. "We're all in this together -- hospitals, surgeons, and implant companies. This closed-door policy of no one telling anyone else what implants cost needs to be addressed to reduce some of the variation and to help limit healthcare expenditures overall."

Comment