OBJECTIVES: Health economic evidence comparing alternative treatments for lumbar spinal stenosis (LSS) is limited. This is a cost comparison of the Superion spacer, laminectomy alone, and fusion for treating LSS based on a payer perspective.

METHODS: We identified de novo patients who underwent decompression surgery for LSS from the Medicare 5% SAF 2016Q1-2018Q2, using the CPT and ICD-10-CM codes, with a 12-month screening and 90-day follow-up. Post-index direct Medicare reimbursements at 30- and 90-day were analyzed, including physician, anesthesiologist, therapist and all other professional services; hospital inpatient and outpatient; rehabilitation inpatient and outpatient; diagnostic, laboratory, as well as home health care. Costs were modeled using the GLM weighted regression with gamma distribution and log link. Stabilized Inverse Probability of Treatment (IPT) weighting was used to adjust for treatment group differences.

RESULTS: The study included 1,855 LSS patients (mean age 72.5, 54% male). Superion (n=79) costs were lower than laminectomy (n=1,451) and fusion (n=325) at both 30- and 90-day post-index. At 30-day, Superion was $2,226 lower than laminectomy (p=0.066) and $3,785 lower than fusion (p=0.002). At 90-day, Superion was $2,868 lower than laminectomy (p=0.079) and $5,012 lower than fusion (p=0.003). When the initial index costs were added, Superion remained lower cost than fusion ($18,300, p<0.001), but higher than laminectomy ($3,187, p=0.033).

CONCLUSIONS: Superion was consistently associated with lower costs than fusion. Superion showed lower 30- and 90-day follow-up cost than laminectomy, but higher when index costs were included. Due to Superion’s higher index cost, longer than a 90-day follow-up is needed to offset the index price differential. Concurrently, a recent CMS proposal of 22% reduction for Superion reimbursement would lead to narrowing of the price gap at index. A brief analysis using this new pricing suggested that at 90-day follow-up, the Medicare reimbursements for Superion and laminectomy would be nearly identical.