Management of Sacroiliac Joint Disruption and Degenerative Sacroiliitis with Nonoperative Care Is Medical Resource-intensive and Costly in a United States Commercial Payer Population.

Ackerman SJ, et al. ClinicoEconomics and Outcomes Research. 2014;6:63-74.


Introduction: Low back pain is common and originates in the sacroiliac (SI) joint in 15%–30% of cases. Traditional SI joint disruption/degenerative sacroiliitis treatments include nonoperative care or open SI joint fusion. To evaluate the usefulness of newly developed minimally-invasive technologies, the costs of traditional treatments must be better understood. We assessed the costs of nonoperative care for SI joint disruption to commercial payers in the United States (US).

Methods: A retrospective study of claim-level medical resource use and associated costs used the MarketScan® Commercial Claims and Encounters as well as Medicare Supplemental Databases of Truven Healthcare. Patients with a primary ICD-9-CM diagnosis code for SI joint disruption (720.2, 724.6, 739.4, 846.9, or 847.3), an initial date of diagnosis from January 1, 2005 to December 31, 2007 (index date), and continuous enrollment for $1 year before and 3 years after the index date were included. Claims attributable to SI joint disruption with a primary or secondary ICD-9-CM diagnosis code of 71x.xx, 72x.xx, 73x.xx, or 84x.xx were identified; the 3-year medical resource use-associated reimbursement and outpatient pain medication costs (measured in 2011 US dollars) were tabulated across practice settings. A subgroup analysis was performed among patients with lumbar spinal fusion.

Results: The mean 3-year direct, attributable medical costs were $16,196 (standard deviation [SD] $28,592) per privately-insured patient (N=78,533). Among patients with lumbar spinal fusion (N=434), attributable 3-year mean costs were $91,720 (SD $75,502) per patient compared to $15,776 (SD $27,542) per patient among patients without lumbar spinal fusion (N=78,099). Overall, inpatient hospitalizations (19.4%), hospital outpatient visits and procedures (14.0%), and outpatient pain medications (9.6%) accounted for the largest proportion of costs. The estimated 3-year insurance payments attributable to SI joint disruption were $1.6 billion per 100,000 commercial payer beneficiaries.

Conclusion: The economic burden of SI joint disruption among privately-insured patients in the US is substantial, highlighting the need for more cost-effective therapies.

Keywords: cost, epidural injection, lumbar spinal fusion surgery

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.