Children’s National Health System ICEOS 2016 – Utrecht, Holland Cost Effectiveness of Magnetically Controlled Growing Rods: Who Really Benefits? Matthew E. Oetgen, MD, MBA Allison Matthews, MS Ellie McNulty Children’s National Health System Washington, DC, USA ICEOS 2016 – Utrecht, Holland

DisclosureS I have nothing to disclose Co-authors disclosures as per final program

Background Traditional Growing Rods (TGR) Treatment of progressive EOS is challenging and costly No single surgical option has become the standard of care due to wide diversity of presenting cases Management of EOS with growing rods has become more common Traditional Growing Rods (TGR) Effective at controlling spinal deformity Require biannual surgical lengthening Magnetically Controlled Growing Rods (MCGR) Effective at controlling spinal deformity No biannual surgical lengthening Significantly more costly

Background Three cost analysis have been published on MCGR These studies all found the following: MCGR is significantly more expensive at the initial implantation MCGR eventually leads to cost benefit compared to TGR - Cost saving appears to be seen at year 3-4 post-implantation - Cost savings seen is most likely due to savings from elimination of repeat surgical lengthenings over time These studies were performed in single payer systems or from payer perspective Questions still remain as to which stakeholders gains these cost savings

Purpose Evaluate the absolute difference in cost for the initial implantation of MCGR compared to TGR 2. Determine the beneficiary of the potential cost savings of MCGR Hypothesis The only significant charge difference for the initial implantation growing rod surgery (TGR vs MCGR) will be the higher implant cost of MCGR, however, hospital reimbursement will remain similar between these two systems.

Methods Retrospective review of all patient who had initial implantation of GR between May 2011 and January 2016 (single institution) Patient information recorded Date of birth Gender, race, diagnosis GR implant type Financial information recorded Type of insurance Total facility charges billed to payer during initial hospitalization Total charge reimbursement to institution Charges were categorized into following groups: anesthesia, surgical implants, laboratory, medication, neuromonitoring, OR materials, radiology, recovery room , room and board, surgery time, therapy Charges for each group were converted into a percentage of total charge for comparison

Results – Overall Population 37 consecutive cases of growing rod implementation were included in the study 21 in the TGR group 16 in the MCGR group 4 TGR to MCGR conversion included in MCGR group Baseline clinical characteristics were similar between the two groups.

Results – Total Overall charges P = 0.04 100% 75% MCGR TGR MCGR total charges 25% more then TGR

Results –Charges per category MCGR TGR Implant charges were the only significantly different charge category (MCGR 2.8x greater then TGR)

Results – Ave % reimbursement of Total charges P = 0.66 45% 43% MCGR TGR No difference in total reimbursement

Conclusions MCGR procedure was found to have significantly higher charges compared to TGR implantation - Difference due to MCGR’s higher implant charge 2. Total institutional charge reimbursement similar between MCGR and TGR for initial implantation hospitalization 3. Despite previous studies showing “cost effectiveness” at 3 years, it appears healthcare institutions solely bear the cost of this new technology while payers gain the long- term financial benefits Better cost accounting is needed to improve to balance between implant costs and future cost savings in MCGR cases.