Patient Financial Burden in Surgical Treatment of Adolescent and Adult Spinal Deformity in the United States.

Study design: Retrospective cohort study.

Objective: To quantify out-of-pocket costs (OOPC) for surgical treatment of adolescent idiopathic scoliosis (AIS) and adult spinal deformity (ASD) in commercially insured patients between 2015 and 2020.

Summary of background data: OOPC related to spinal deformity surgery can present a significant financial burden on patients. Previous studies have explored surgical costs, but few have examined OOPC specifically for AIS and ASD in commercially insured populations. This study provides an analysis of OOPC and insurance payments.

Methods: We utilized a large commercial insurance claims database to identify patients undergoing surgery for AIS (ages 10-25) and ASD (≥40 y) from 2015 to 2020. The surgical care episode was defined from 180 days pre-operative to 30 days post-operative. OOPC and total net payments from insurance were calculated and adjusted to 2020 dollars.

Results: A total of 2,869 AIS and 1,528 ASD patients were included. Median ages were 15.0±2.5 years (AIS) and 58.0±6.2 years (ASD). The median OOPC for AIS surgery was $3,231 (SD 2,615), representing 2.6% of total net payments, while ASD surgery had a median OOPC of $2,559 (SD 2,803), representing 1.8%. HDHP patients faced the highest OOPC. The total net payments from commercial insurance were $119,493 (SD 71,480) for AIS and $140,822 (SD 112,060) for ASD. OOPC and total net payments did not significantly increase from 2015 to 2020 (P>0.1).

Conclusion: OOPC for AIS and ASD surgeries remain substantial, particularly for patients with HDHPs. High OOPC may contribute to delays in care or deferral of surgery. Financial counseling, cost transparency, and policy efforts aimed at mitigating OOP burden are important steps to improve timely access to spine surgery and reduce the risk of financial strain for patients.