Healthcare utilization and costs for spinal conditions in Ontario, Canada - opportunities for funding high-value care: a retrospective cohort study

Abstract Background Context An important step in improving spinal care is understanding how current healthcare resources and associated cost are being utilized and distributed across a healthcare system. Purpose Our objective was to examine the magnitude and distribution of direct healthcare costs for spinal conditions across physician type and hospital setting. Design/Setting Cross-sectional analysis of administrative health data for the fiscal year 2013-2014 from the province of Ontario, Canada. Patient Sample Adult population aged 18+ years (N=10,841,302) Outcome Measures Person visit rates and total number of people and visits by specific care settings were calculated for all spinal conditions as well as stratified by non-trauma and trauma-related conditions. Variation in rates by age and sex was examined. The proportion of patients seeing physicians of different specialties was calculated for each condition grouping. Direct medical costs were estimated and their percentage distribution by care setting calculated for non-trauma and trauma-related conditions. Additionally, costs for spinal imaging overall and stratified by type of scan were determined. Methods Administrative health databases were analyzed, including data on physician services, emergency department visits and hospitalizations. ICD-9 and -10 diagnostic codes were used to identify non-traumatic (degenerative or inflammatory) and traumatic spinal disorders. A validated algorithm was used to estimate direct medical costs. Results Overall, 822,000 adult Ontarians (7.6%) made 1.6 million outpatient physician visits for spinal conditions; the majority (1.1 million) of these visits were for non-trauma conditions. Approximately, 86% of outpatient visits were in primary care. Emergency Department (ED) visits for non-trauma spinal conditions (130,000 out of 156,000 ED visits) accounted for 2.8% of all ED visits in the province. Total costs for spine-related care were $264 million (CDN) with 64% of costs due to non-trauma conditions. For these non-trauma conditions, ED visits cost $28 million for 130,000 visits ($215 per visit). For $32 million spent in primary care, 890,000 visits were made ($36 per visit). Spine imaging costs were $66.5 million, yielding a combined total of $330 million in health care spending for spinal conditions. Conclusions Spinal conditions place a large and costly burden on the healthcare system. The disproportionate annual cost associated with ED visits represents a potential opportunity to redirect costs to fund more clinically and cost-effective models of care for non-traumatic spinal conditions.