• Y Raja Rampersaud, J Denise Power, Anthony V Perruccio, J Michael Paterson, Christian Veillette, Peter C Coyte, Elizabeth M Badley, and Nizar N Mahomed.
• Arthritis Program, Krembil Research Institute, University Health Network, 60 Leonard Ave, Toronto, ON M5T 0S8 Canada; Department of Surgery, University of Toronto, 149 College Street, 5th Floor, Toronto, ON M5T 1P5, Canada. Electronic address: raja.rampersaud@uhn.ca.
• Spine J. 2020 Jun 1; 20 (6): 874-881.

Background ContextAn important step in improving spinal care is understanding how current health-care resources and associated cost are being utilized and distributed across a health-care system.PurposeOur objective was to examine the magnitude and distribution of direct health care costs for spinal conditions across physician type and hospital setting.Design/SettingCross-sectional analysis of administrative health data for the fiscal year 2013-2014 from the province of Ontario, Canada.Patient SampleAdult population aged 18+ years (N=10,841,302).Outcome MeasuresPerson visit rates and total number of people and visits by specific care settings were calculated for all spinal conditions as well as stratified by nontrauma 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 nontrauma and trauma-related conditions. Additionally, costs for spinal imaging overall and stratified by type of scan were determined.MethodsAdministrative health databases were analyzed, including data on physician services, emergency department visits, and hospitalizations. ICD-9 and -10 diagnostic codes were used to identify nontraumatic (degenerative or inflammatory) and traumatic spinal disorders. A validated algorithm was used to estimate direct medical costs.ResultsOverall, 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 nontrauma conditions. Approximately, 86% of outpatient visits were in primary care. Emergency Department (ED) visits for nontrauma 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 nontrauma conditions. For these nontrauma 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.ConclusionsSpinal conditions place a large and costly burden on the health-care 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 nontraumatic spinal conditions.Copyright © 2020 The Authors. Published by Elsevier Inc. All rights reserved.

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