SUBJECT: Non-coverage Decision for Washington State HTA Re-review of Lumbar
ADR: 20170120B.
Dear Mr. Morse:
We, the American Association of Neurological Surgeons (AANS), Congress of Neurological
Surgeons (CNS), AANS/CNS Joint Section on Disorders of the Spine and Peripheral Nerves,
Washington State Association of Neurological Surgeons (WSANS), International Society for the
Advancement of Spine Surgery and North American Spine Society (NASS), herewith express our
resolute disagreement with the January 20, 2017, decision of the Washington State Healthcare
Authority (HCA) Health Technology Assessment (HTA) program Health Technology Clinical
Committee (HTCC) not to cover lumbar artificial disc replacement (ADR) surgery for all FDA
approved indications. We concur with the decision to expand coverage to two level for cervical ADR
as stated in the draft decision.
For the record, our combined societies express our concerns on behalf of our patients that we as
medical professionals are entrusted to care for. Moreover, we are deeply concerned about the
flawed process for re-review of the ADR lumbar policy, as well as the content of the draft findings
and decision for ADR lumbar rendered by the HTCC on January 20, 2017. The member physicians
of our professional societies wish it to be known that patients experiencing certain forms of severe
life-altering low back pain, which has been shown to be refractory to all appropriate forms of
nonoperative care, will be denied access to effective surgical treatment with the more recent
January 20, 2017 decision. To be clear, we support the 2008 ADR lumbar decision, which
permitted coverage under certain conditions following a period of nonoperative care. However, this
recent decision is not compatible with the latest scientific evidence or reasonable methodology, nor
does it reflect our professional experience of caring for our patients in the United States, nor was
this re-review of lumbar disc replacement even necessary by the HTA/HTCC’s own standards.
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