Comparison of the costs of nonoperative care to minimally invasive surgery for sacroiliac joint disruption and degenerative sacroiliitis in a United States Medicare population: potential economic implications of a new minimally-invasive technology

Ackerman SJ, et al. ClinicoEconomics and Outcomes Research. 2013;5:575-587.

Abstract

Introduction: The economic burden associated with the treatment of low back pain (LBP) in the United States is significant. LBP caused by sacroiliac (SI) joint disruption/degenerative sacroiliitis is most commonly treated with nonoperative care and/or open SI joint surgery. New and effective minimally invasive surgery (MIS) options may offer potential cost savings to Medicare.

Methods: An economic model was developed to compare the costs of MIS treatment to nonoperative care for the treatment of SI joint disruption in the hospital inpatient setting in the US Medicare population. Lifetime cost savings (2012 US dollars) were estimated from the published literature and claims data. Costs included treatment, follow-up, diagnostic testing, and retail pharmacy pain medication. Costs of SI joint disruption patients managed with nonoperative care were estimated from the 2005–2010 Medicare 5% Standard Analytic Files using primary International Classification of Diseases, Ninth Revision, Clinical Modification (ICD-9-CM) diagnosis codes 720.2, 724.6, 739.4, 846.9, or 847.3. MIS fusion hospitalization cost was based on Diagnosis Related Group (DRG) payments of $46,700 (with major complications - DRG 459) and $27,800 (without major complications - DRG 460), weighted assuming 3.8% of patients have complications. MIS fusion professional fee was determined from the 2012 Medicare payment for Current Procedural Terminology code 27280, with an 82% fusion success rate and 1.8% revision rate. Outcomes were discounted by 3.0% per annum.

Results: The extrapolated lifetime cost of treating Medicare patients with MIS fusion was $48,185/patient compared to $51,543/patient for nonoperative care, resulting in a $660 million savings to Medicare (196,452 beneficiaries at $3,358 in savings/patient). Including those with ICD-9-CM code 721.3 (lumbosacral spondylosis) increased lifetime cost estimates (up to 478,764 beneficiaries at $8,692 in savings/patient).

Conclusion: Treating Medicare beneficiaries with MIS fusion in the hospital inpatient setting could save Medicare $660 million over patients’ lifetimes.

Keywords: sacroiliac joint disruption, degenerative sacroiliitis, minimally invasive surgery, epidural injection, iFuse, cost

Disclosure: This study was sponsored by SI-BONE, Inc. (San Jose, CA, USA). SI-BONE did not participate in the data analysis, interpretation of the results, or writing of the manuscript. SI-BONE was provided a final version of the manuscript for informational purposes only. It did not influence the content or writing of the manuscript. SJA, KS, and TK are consultants to SI-BONE through their employment at Covance. DWP has not received any financial support from SI-BONE. DWP 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. Portions of this work have been presented as an abstract to the 8th Interdisciplinary World Congress on Low Back and Pelvic Pain, and have been accepted to the Society for Minimally Invasive Spine Surgery 2013. The authors report no other conflicts of interest in this work.