1. Children’s National Health System ICEOS 2016 – Utrecht, Holland
Cost Effectiveness of Magnetically
Controlled Growing Rods:
Who Really Benefits?
Matthew E. Oetgen, MD, MBA
Allison Matthews, MS
Ellie McNulty
Children’s National Health System
Washington, DC, USA
ICEOS 2016 – Utrecht, Holland

2. DisclosureS I have nothing to disclose
Co-authors disclosures as per final program

3. Background Traditional Growing Rods (TGR)
Treatment of progressive EOS is challenging and costly
No single surgical option has become the standard of care due
to wide diversity of presenting cases
Management of EOS with growing rods has become more
common
Traditional Growing Rods (TGR)
Effective at controlling spinal deformity
Require biannual surgical lengthening
Magnetically Controlled Growing Rods (MCGR)
Effective at controlling spinal deformity
No biannual surgical lengthening
Significantly more costly

4. Background
Three cost analysis have been published on MCGR
These studies all found the following:
MCGR is significantly more expensive at the initial implantation
MCGR eventually leads to cost benefit compared to TGR
- Cost saving appears to be seen at year 3-4 post-implantation
- Cost savings seen is most likely due to savings from elimination of repeat surgical lengthenings over time
These studies were performed in single payer systems or from payer perspective
Questions still remain as to which stakeholders
gains these cost savings

5. Purpose
Evaluate the absolute difference in cost for the initial
implantation of MCGR compared to TGR
2. Determine the beneficiary of the potential cost savings
of MCGR
Hypothesis
The only significant charge difference for the initial
implantation growing rod surgery (TGR vs MCGR) will
be the higher implant cost of MCGR, however, hospital
reimbursement will remain similar between these
two systems.

6. Methods
Retrospective review of all patient who had initial implantation of
GR between May 2011 and January 2016 (single institution)
Patient information recorded
Date of birth
Gender, race, diagnosis
GR implant type
Financial information recorded
Type of insurance
Total facility charges billed to payer during initial hospitalization
Total charge reimbursement to institution
Charges were categorized into following groups: anesthesia,
surgical implants, laboratory, medication, neuromonitoring, OR materials,
radiology, recovery room , room and board, surgery time, therapy
Charges for each group were converted into a percentage of total
charge for comparison

7. Results – Overall Population
37 consecutive cases of growing rod implementation were included in the study
21 in the TGR group
16 in the MCGR group
4 TGR to MCGR conversion included in MCGR group
Baseline clinical characteristics were similar between
the two groups.

8. Results – Total Overall charges
P = 0.04
100%
75%
MCGR
TGR
MCGR total charges 25% more then TGR

9. Results –Charges per category
MCGR TGR
Implant charges were the only significantly different
charge category (MCGR 2.8x greater then TGR)

10. Results – Ave % reimbursement of Total charges
P = 0.66
45%
43%
MCGR
TGR
No difference in total reimbursement

11. Conclusions
MCGR procedure was found to have significantly higher charges compared to TGR implantation
- Difference due to MCGR’s higher implant charge
2. Total institutional charge reimbursement
similar between MCGR and TGR for initial implantation
hospitalization
3. Despite previous studies showing “cost effectiveness” at
3 years, it appears healthcare institutions solely bear the
cost of this new technology while payers gain the long-
term financial benefits
Better cost accounting is needed to improve to balance between
implant costs and future cost savings in MCGR cases.