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