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Table 3 Data on outcomes, costs and healthcare use, effectiveness, and costs

From: Second opinions for spinal surgery: a scoping review

Study, year Surgery rates Patient-reported outcomes Costs Healthcare use
Lenza, 2017   Between-group MD (95% CI)
Pain (0–10): 0.5 (−0.5 to 1.6)
RMDQ (0–24): 1.5 (−1.6 to 4.7)
ODI (0–100): 27.4 (−7.1 to 7.3)
  
Marnitz, 2019 Patients receiving surgery within 12 months, n/N (%)
Second opinion: 47/108 (44%)
No second opinion: 81/108 (75%)
Between group difference (95% CI):
32% (19 to 43%)
   
Viola, 2013    Estimated cost (USD) of treatment after second opinion versus cost initially proposed (difference):
- Surgery: $1,002,826 vs $1,228,117 (difference: $225,291; −18%)
- Conservative: $184,304 vs $1,840,976 (difference: $1,656,672; −90%)
- Total: $1,187,294 vs 3,069,094
(difference: $1,881,800; −61%)
 
Fox, 2013 Surgery rates per 1000 plan members pre/post program implementation (2006–7 vs 2008–10):
2.7 vs 1.9 (−29%)
  Costs pre (2006–07) versus post-implementation (2007–08) (USD, % change):
- Surgical costs per member per month: $9.75 vs $7.29 (−25%)
- Total spinal-related costs per member per month: $19.7 vs $17.4 (− 12%)
- Average reimbursement for surgery: $21,250 vs $22,853
Healthcare use pre (2006–07) versus post-implementation (2007–08) (% change):
- Physiatrist consultations per 1000 members: 5 vs 8.5 (+ 69.5%)
- New surgical consultations per 1000 members: 7.2 vs 3.7 (−48%)
- Advanced imaging (CT or MRI) per 1000 members: 14 vs 11.6 (− 17.7%)
- Electrodiagnostic testing, % of cases: 21% vs 24% (+ 14%)
- Spinal injections, % of cases: 42% vs 44% (+ 4%)
Goodman, 2016 Surgery rates per 100,000 population pre-post program implementation (2008–2013):
68 vs 74 (+ 8%)
  Costs pre (versus post-implementation (USD, % change): $4338 vs $7940 (+ 83%)
Percentage of incremental costs with non-surgical care per type of service considering an average increase in cost post-implementation of $3602 per member:
- Emergency: $326 (9%)
- Urgent care: $1 (0%)
- Observation stays: $209 (6%)
- Inpatient admissions: $666 (19%)
- Office visits: $379 (11%)
-Physiotherapy visits: $290 (8%)
- Radiology: $437 (12%)
- Chiropractic: $-1 (0%)
- Prescription drugs: $460 (13%)
- Lumbar injections: $835 (23%)
 
Lien, 2020    Mean (SD; range) cost of second opinion services across 30 hospitals in the US:
$493 ($343; $90–$1300)
Average cost of second opinion services provided online: $643 ($259; $100–$850)