Prevalence & Economic Burden of Adult Spinal Deformity in a Large United States Commercial Payer Population.

Purpose: Evaluate the prevalence and economic burden of adult spinal deformity (ASD) in a large, United States (US) commercial payer population. Patients and Methods: Patients aged 21-64 having an encounter with an ASD diagnosis from the Merative Results: Annual ASD prevalence was 0.50%. 169,855 patients (46±13 years, 67.7% female) had an outpatient ASD encounter and were included in the economic burden cohort. Total spine-related payer expenditures averaged $7,619 (95% CI; $7,438, $7,800) per patient within 1 year - a payer burden of $3.8 million per 100,000 commercially-insured beneficiaries. Spine-related societal expenditures were $8,759 ($8,570, $8,947) per patient within 1 year - a societal burden of $6.2 billion among the US commercially-insured population. Nonoperative costs comprised 44% of the 1-year payer burden and 48% of the societal burden. While surgical treatment rates were low (3.5% fusions and 2.9% decompressions within 1 year), the associated economic burden was high (55% of payer burden, 51% of societal burden). The 2-year cumulative payer burden totaled $5.4 million per 100,000 commercially-insured beneficiaries, and the US commercially-insured societal burden totaled $8.9 billion. Conclusion: The burden of both operative and nonoperative care for ASD is large. Considerable opportunity exists for development of improved nonoperative treatment modalities to increase the value of ASD care by reducing the need for continued nonoperative interventions of limited benefit and reducing the use of costly surgical interventions.