Comparison of the Costs of Nonoperative Care to Minimally Invasive Surgery for Sacroiliac Joint Disruption and Degenerative Sacroiliitis in a United States Commercial Payer Population: Potential Economic Implications of a New Minimally Invasive Technology

Ackerman SJ, et al. ClinicoEconomics and Outcomes Research. 2014;6:283-96.


Introduction: Low back pain is common and treatment costly with substantial lost productivity and lost wages in the working-age population. Chronic low back pain originating in the sacroiliac (SI) joint (15%–30% of cases) is commonly treated with nonoperative care, but new minimally invasive surgery (MIS) options are also effective in treating SI joint disruption. We assessed whether the higher initial MIS SI joint fusion procedure costs were offset by decreased nonoperative care costs from a US commercial payer perspective.

Methods: An economic model compared the costs of treating SI joint disruption with either MIS SI joint fusion or continued nonoperative care. Nonoperative care costs (diagnostic testing, treatment, follow-up, and retail pharmacy pain medication) were from a retrospective study of Truven Health MarketScan® data. MIS fusion costs were based on the Premier’s Perspective™ Comparative Database and professional fees on 2012 Medicare payment for Current Procedural Terminology code 27280.

Results: The cumulative 3-year (base-case analysis) and 5-year (sensitivity analysis) differentials in commercial insurance payments (cost of nonoperative care minus cost of MIS) were $14,545 and $6,137 per patient, respectively (2012 US dollars). Cost neutrality was achieved at 6 years; MIS costs accrued largely in year 1 whereas nonoperative care costs accrued over time with 92% of up front MIS procedure costs offset by year 5. For patients with lumbar spinal fusion, cost neutrality was achieved in year 1.

Conclusion: Cost offsets from new interventions for chronic conditions such as MIS SI joint fusion accrue over time. Higher initial procedure costs for MIS were largely offset by decreased nonoperative care costs over a 5-year time horizon. Optimizing effective resource use in both nonoperative and operative patients will facilitate cost-effective health care delivery. The impact of SI joint disruption on direct and indirect costs to commercial insurers, health plan beneficiaries, and employers warrants further consideration.

Keywords: epidural injection, iFuse, economic model, sacroiliac joint fusion, sacroiliac joint pain, insurance

DisclosureThis research was performed according to guidelines (GPP2) established to minimize conflict of interest in pharmacoeconomic studies.18,19 A multispecialty panel comprising clinicians and methodologists (the coauthors) provided the framework for the economic analysis and completed the data analysis and interpretation of the results. This study was sponsored by SI-BONE, Inc. SI-BONE, Inc, did not participate in the data analysis, interpretation of the results, or writing of the manuscript. SI-BONE, Inc, was provided a final version of the manuscript for informational purposes only. It did not influence the content or writing of the manuscript. SJA and TK are consultants to SI-BONE, Inc, through their employment with Covance. DWP Jr has not received any financial support from SI-BONE, Inc. DWP Jr receives research support from the Department of Defense, Orthopaedic Research and Education Foundation, Minnesota Medical Foundation, and Chest Wall and Spine Deformity Foundation. TH and JC are paid teaching and clinical research consultants for SI-BONE, Inc. Portions of this work have been accepted as an abstract to the 14th Annual Conference of the International Society for the Advancement of Spine Surgery and will be presented as a poster. The authors report no other conflicts of interest in this work.