Comparing Medicare Claims in Patients with Lumbar Discogenic Pain Managed Conservatively or with Intradiscal Nucleus...

Minimally invasive intradiscal procedures such as nucleus pulposus (NP) allograft have been advocated as first-line interventions in patients with lumbar discogenic pain that fail to respond to conservative care.

The objective of this retrospective study was to assess the impact of a commercially available NP allograft (VIA Disc NP) on claims-based outcomes among Medicare beneficiaries with symptomatic degenerative disc disease (DDD). NP allograft patients were compared with a matched group of DDD patients managed conservatively. Use of the 100% Medicare database identified a sample size of 1804 cases per group matched on a one-to-one basis on age, sex, baseline Charlson-Comorbidity Index, disc degeneration, radiculopathy, disc displacement (herniation), spondylosis/facet arthropathy, and baseline chronic opioid therapy. Data extraction was restricted to the period, August 2021 to December 31, 2024. All patients had ≥12 months of continuous enrollment with medical benefits preceding and following the index date. Outcomes included opioid usage, imaging utilization, physical therapy, epidural steroid injections, spinal fusion procedures, and physician preference.

There was a significant reduction in the mean total number of opioid prescriptions (3.3 ± 4.9 vs. 2.6 ± 3.9, P=0.001), the mean total days' supply of opioids (129.3 ± 165.1 vs. 89.8 ± 133.2 days, P=0.001), and imaging utilization frequency (81% vs. 46%, P=0.0001) between the 12-month baseline period and the 12-month follow-up period after the index NP allograft procedure. There were statistically significant differences in utilization rates between study groups for physical therapy (76% vs. 40%, P=0.0001) and epidural steroid injections (55% vs. 31%, P=0.0001), equating to reductions in resource utilization of 47% and 44%, respectively, following intradiscal treatment. Fusion rates were low in both study groups (6% vs. 6%, P=0.53).

This analysis showed that the commercial introduction of a clinically effective first-line intervention in the continuum of care of patients with lumbar discogenic pain is associated with a reduction in the number and type of medical claims for this condition in the Medicare population.