Declining Utilization and Inflation-Adjusted Expenditures for Epidural Procedures in Chronic Spinal Pain in the...

Area of Science:

• Pain Management
• Health Economics
• Interventional Procedures

Background:

• Epidural steroid injections are common for chronic spinal pain.
• Analysis of expenditure patterns for these procedures is limited.

Purpose of the Study:

• To assess expenditures for epidural procedures in the fee-for-service (FFS) Medicare population from 2009 to 2018.
• To analyze trends in utilization and cost adjusted for inflation.

Main Methods:

• Utilized a 5% national sample of Medicare FFS physician outpatient billing claims (2009-2018).
• Analyzed expenditures for all settings and providers.
• Adjusted all costs to 2018 US dollars for inflation.

Main Results:

• Total expenditures increased by 14.6% (1.5% annually) before inflation adjustment.
• Inflation-adjusted expenditures decreased by 2% overall (0.2% annually).
• Inflation-adjusted per-patient costs decreased by 17.2% (2.1% annually).
• Transforaminal epidurals showed higher costs and increased annually, while lumbar/caudal epidurals decreased.

Conclusions:

• Despite overall expenditure increases, inflation-adjusted costs for epidural procedures declined.
• Transforaminal epidurals represent a higher cost intervention compared to lumbar/caudal epidurals.
• Utilization, adjusted for inflation, showed a decrease in epidural procedures per capita.