Impact of a second medical opinion on the therapeutic and costs management of lumbar pathologies : a study based on a French cohort

Introduction: It is increasingly common for a patient to seek a second opinion after a therapeutic proposal, particularly surgical, for a spinal pathology. We studied the impact of this second opinion, obtained via a platform specialized in this approach, on the final therapeutic decision. Methods & Materials: Between 2019 and 2021, 309 second medical opinions (SMO) were obtained on the deuxiemeavis.fr platform for degenerative lumbar pathologies (hernias, discopathies, stenoses). The referring physicians studied the patients' disabilities using personalized questionnaires and their additional examinations. We analysed the concordance rate between the two opinions. Patients were asked about their degree of satisfaction. The costs of care were studied according to a cost minimization principle: all medical costs were considered based on treatment protocols, as well as the costs of insurance, relating to work stoppages. Any additional costs or savings generated were evaluated by opinion, convergent or divergent, and for divergent opinions only. The average cost of the converging arm was considered as the reference cost. We then compared the cost of the care recommended by the SMOs to this reference cost. Those of compulsory health insurance (AMO) have been distinguished from those of supplementary health insurance (AMC). Results: 69% of the SMOs (212 opinions) were convergent and 31% (97 opinions) divergent, differing mainly on the therapeutic strategies as recommended by the High Authority of Health (HAS): contraindication or recommendation of surgery, proposal of infiltrations, pain management, rehabilitation or referral to another specialist (rheumatologist, surgeon). Some divergences concerned the diagnosis, or the examinations carried out. Regardless of the convergent or divergent direction resulting from the second opinion, out of 309 patients, the health insurance system sees on average all medical and welfare costs per patient decrease by €550, including €322 for AMO and €228 for AMC (excluding deuxième.avis.fr costs). When the second opinion diverges from the initial opinion, the savings observed in terms of medical and welfare expenses are on average €1,751 per file including €1,025 for AMO and €726 for AMC. Conclusion: Using a second medical opinion service via a dedicated platform allows patients to seek the advice of a referring physician in lumbar pathology, without the aim of directly interfering in the patient's care. In more than two-thirds of cases, it allows the patient to be reassured about the initially proposed treatment by confirming the first opinion. In divergent cases, the referring physician generally suggests a less invasive treatment, thus resulting in real healthcare savings, estimated at €1,751 per case.