Health Care Utilization Among Medicare Beneficiaries with Newly Diagnosed Low Back Pain

Introduction: By 2030, 1 in 5 adults in the United States will be 65 or older. Among older adults, low back pain (LBP) is the most common medical cause of pain and disability. In this study, we quantify healthcare utilization costs among Medicare beneficiaries with newly diagnosed LBP, compare costs between patients managed operatively and nonoperatively, and identify costs associated with nonadherence to treatment guidelines.

Methods: Patients with new-onset atraumatic mechanical LBP were queried from a 20% sample of CMS’ Medicare data via ICD codes. The study period was 2003-2018. Patients were excluded if they had concomitant or previous diagnoses that could cause LBP of non-mechanical etiologies (e.g., malignancy). The primary outcome was total costs of care in the year of the patient’s diagnosis, stratified by whether the patient underwent spinal surgery during that year. To assess whether patients who were managed nonoperatively received care in accordance with proposed guidelines, the utilization and costs of different healthcare services were tabulated.

Results: 1,269,896 patients were identified; 23,919 (1.8%) underwent surgery. These patients accounted for 7% of the cohort’s total cost, corresponding to $514 million ($21,496 per person). By contrast, patients treated nonoperatively accounted for over $7 billion in costs ($5,880 per person; p< 0.001). Within the nonoperative cohort, 626,896 (50.3%) patients were nonadherent to current guidelines for conservative management of LBP. 460,099 (30.9%) underwent imaging within 30 days of diagnosis, while 619,473 (49.7%) received imaging before a trial of physical therapy. Guideline nonadherence increased total annual costs by $4,012 per person ($7,873 for nonadherent vs. $3,861 for adherent patients, p< 0.001). Guideline adherence could have therefore saved over $2.5 billion in total healthcare costs over the study period.

Conclusion : Nonoperative management of low back pain is associated with significantly lower costs per patient, and adherence to proposed treatment guidelines can save billions of dollars in healthcare costs.