Cost of implants is a barrier to spinal deformity surgery in low income countries


Richard Schwend (Children’s Mercy Hospital and Clinics, Kansas City, USA) told delegates attending this year’s International Meeting for Advanced Spine Techniques (IMAST; 16–19 July, Valencia, Spain) that implant costs and unsafe surgical facilities are among the principal barriers to children having corrective surgery for spinal deformity in low income countries even though the costs of pedicle screws is lower in these countries than in high income countries.


Schwend reported that the cost of pedicle screws “may restrict access to surgical care for children” and, therefore, the aim of the present study was to investigate “how implant costs impact paediatric spinal deformity surgery globally. He and the lead author of the study, Sreeharsha Nandyala (University of Missouri Kansas City School of Medicine, Kansas City, USA), sent a 28-item survey (through Research Electric Data Capture) to published spinal surgeons and to members of the Scoliosis Research Society. The survey asked questions on patient characteristics, the cost of pedicle screws, strategies used to reduce the costs of implants and surgeries, and the barriers to paediatric spinal deformity surgery in the surgeons’ countries.

Overall, of 441 spinal surgeons in 58 countries contacted, 95 surgeons from 36 countries responded. Of these, 70 (74%) were from high income countries (gross national income per capita more than US $12,616) and 25 (26%) were from low income countries. Schwend noted that significantly more patients in low income countries pre-purchased implants from a vendor (45% vs. 3% respectively; p<0.001) or from the surgeon (30% vs. 2%, respectively; p<0.001) than patients in high income countries, and that these patients were more likely to use charity funds to pay for the surgery (72% vs. 40%, respectively; p=0.009). There were no significant differences between groups in the use of government funds.

Schwend also reported that while more surgeons in low income countries preferred to use older, refurbished or donated implants than high income countries to save implant costs, more surgeons in high income preferred to use volume-based or price-based negotiations with the vendor. Furthermore, surgeries in high income countries were associated with greater pedicle screw costs, regardless of manufacturing location, than in low income countries (p<0.05).

However, implant costs—alongside unsafe surgical facilities–were significant more likely to be listed as a principal barrier to access for children needing spinal deformity surgery in low income countries. He concluded: “A prospective study that includes more surgeons from a variety of low income countries and practises should provide more accurate and representative data.”