# Reducing the Cost of Spinal Fixation Surgeries to Fit the Budgets of Patients From the Low- and Middle-Income Categories to Ensure Affordable and Effective Outcomes

## TL;DR

This study finds that using cheaper spinal implants and shorter surgical techniques can significantly lower surgery costs without harming patient outcomes, making it more accessible for low- and middle-income patients.

## Contribution

The study identifies implant costs as the main expense in spinal surgeries and proposes cost-effective alternatives that maintain surgical effectiveness.

## Key findings

- Implants, especially screws and rods, account for 59% of the total surgery cost.
- Using short-segment fixation and less expensive implants significantly reduced costs without affecting outcomes.
- Post-operative complications and neurological improvements were similar between cost-reduced and standard groups.

## Abstract

Background and objective

Traumatic spinal cord injury often results in significant disability, requiring timely surgical intervention to reduce long-term consequences. In low- and middle-income countries, the fragmented healthcare system and high out-of-pocket costs limit access to spinal fixation surgeries, especially for those in the lower income groups. This study aimed to identify the major cost drivers of spinal fixation surgeries and explore strategies to reduce them, making them more affordable for patients without compromising outcomes.

Methodology

This study, conducted at a tertiary care hospital, included 120 patients with traumatic spinal injuries. We analyzed costs related to surgery, including laboratory, radiology, pharmacy, and implant expenses, and compared a prospective group with cost-reducing strategies to a retrospective group.

Results

A total of 120 patients (60 in each group) participated in the study. The major cost driver identified was the implants, particularly screws and rods, which constituted 59% of the total cost of surgery. In the prospective group, the use of short-segment fixation and less expensive implant materials (e.g., titanium mesh cages and metallic disc spacers) led to a significant reduction in costs compared to the retrospective group. Though the mean cost of the implants was significantly lower in the prospective group, there was no difference in surgical outcomes between the two groups. Post-operative complications and readmission rates were similar in both groups and outcomes in terms of neurological improvement were also comparable.

Conclusion

Implant costs are the primary driver of expenses in spinal surgeries. Using short-segment fixation and cost-effective implants reduce costs without affecting outcomes, improving access for patients belonging to low- and middle-income categories. Further studies are needed to evaluate the long-term cost-effectiveness of this strategy.