P83. Patient preferences and willingness to cost share in spine surgery

BACKGROUND CONTEXT As novel spine surgical technologies emerge, their perceived value by patients is not well understood. Additionally, payors have continued to limit access to certain aspects of spine surgery due to costs, and little is known about patient perceptions and preferences on willingness to incur out of pocket expenses regarding spine surgery. PURPOSE The purpose of this study is to better understand patient preferences and willingness to cost share for access to additional surgical options. STUDY DESIGN/SETTING Cross-Sectional Study. PATIENT SAMPLE Adult patients who presented to the Spine Surgery Center. OUTCOME MEASURES Patient preferences and willingness to cost share for additional spine surgical options. METHODS An anonymous survey was distributed to patients with an emphasis that responses would have no impact on clinical care. The survey queried patient demographics, education level, insurance, income, and willingness to pay for standard consumer goods, such as a car or phone. Patients were also asked their perceptions about the costs of surgical expenditures and their willingness to incur out of pocket expenses for additional surgical options that would not be covered by their insurance. Additional surgical expenses included use of personalized implants, use of navigation, use of robotics, and use of minimally invasive techniques. RESULTS One hundred patients completed the questionnaire with the largest proportion of each demographic being male (52%), 60-70 years old (31%), high school educated (32%), privately insured (42%), and with a household income of $100,000-$200,000 (30%). A total of 78% of patients stated that they would be unsatisfied with a standard of care surgical option selected by their insurance and 87% stated they would be willing to contribute to out of pocket expenses. Sixty-eight percent of respondents stated that patients should have a choice of implants with a copay, while 22% believe that every patient should receive the same implant as chosen by the hospital. A majority of patients (70%) thought that spine implants cost greater than $10,000, however, only 45% felt that implants should cost greater than $10,000. For those who were willing to incur out of pocket expenses, the largest percentage of patients (29%) were willing to pay greater than $10,000 for additional surgical options. In every option queried, the largest proportion stated that they would pay greater than $10,000 for additional technologies, including personalized implants (31%), use of navigation (31%), use of robotics (27%), and minimally invasive techniques (32%). In a regression model, household income, age, education level, and value of standard consumer goods were associated with amount of willingness to pay for additional surgical options. CONCLUSIONS The majority of patients would like the ability to cost share in their surgical planning for personalized options, including patient-specific implants, navigation use, robotic use, and minimally invasive techniques. Spine surgery patients generally believe that surgical implants and technologies cost greater than $10,000 and would be willing to contribute greater than $10,000 for additional options. Spine surgery patients place a high value on personalized surgical technologies and are willing to cost share to access newer technologies. FDA Device/Drug Status This abstract does not discuss or include any applicable devices or drugs. As novel spine surgical technologies emerge, their perceived value by patients is not well understood. Additionally, payors have continued to limit access to certain aspects of spine surgery due to costs, and little is known about patient perceptions and preferences on willingness to incur out of pocket expenses regarding spine surgery. The purpose of this study is to better understand patient preferences and willingness to cost share for access to additional surgical options. Cross-Sectional Study. Adult patients who presented to the Spine Surgery Center. Patient preferences and willingness to cost share for additional spine surgical options. An anonymous survey was distributed to patients with an emphasis that responses would have no impact on clinical care. The survey queried patient demographics, education level, insurance, income, and willingness to pay for standard consumer goods, such as a car or phone. Patients were also asked their perceptions about the costs of surgical expenditures and their willingness to incur out of pocket expenses for additional surgical options that would not be covered by their insurance. Additional surgical expenses included use of personalized implants, use of navigation, use of robotics, and use of minimally invasive techniques. One hundred patients completed the questionnaire with the largest proportion of each demographic being male (52%), 60-70 years old (31%), high school educated (32%), privately insured (42%), and with a household income of $100,000-$200,000 (30%). A total of 78% of patients stated that they would be unsatisfied with a standard of care surgical option selected by their insurance and 87% stated they would be willing to contribute to out of pocket expenses. Sixty-eight percent of respondents stated that patients should have a choice of implants with a copay, while 22% believe that every patient should receive the same implant as chosen by the hospital. A majority of patients (70%) thought that spine implants cost greater than $10,000, however, only 45% felt that implants should cost greater than $10,000. For those who were willing to incur out of pocket expenses, the largest percentage of patients (29%) were willing to pay greater than $10,000 for additional surgical options. In every option queried, the largest proportion stated that they would pay greater than $10,000 for additional technologies, including personalized implants (31%), use of navigation (31%), use of robotics (27%), and minimally invasive techniques (32%). In a regression model, household income, age, education level, and value of standard consumer goods were associated with amount of willingness to pay for additional surgical options. The majority of patients would like the ability to cost share in their surgical planning for personalized options, including patient-specific implants, navigation use, robotic use, and minimally invasive techniques. Spine surgery patients generally believe that surgical implants and technologies cost greater than $10,000 and would be willing to contribute greater than $10,000 for additional options. Spine surgery patients place a high value on personalized surgical technologies and are willing to cost share to access newer technologies.