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

Abstract

IntroductionLow 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.MethodsAn 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.ResultsThe 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.ConclusionCost 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.

Cost-effectiveness of minimally invasive sacroiliac joint fusion

“…This is a conservative assumption, given that studies have shown that non-surgical treatment of SIJ pain has persistent yearly costs, presumably to maintain clinical response. 56 , 57 …”

Minimally Invasive Sacroiliac Joint Fusion: The Current Evidence

“…Similarly, in this era of value-based health care, cost-effectiveness is an important benchmark, and several articles did address this topic. [50][51][52][53][54] However, we feel that a thorough review of these articles is outside the scope of this manuscript. Lastly, the pooled analysis presented here is not meant to determine the superiority of one implant device or one approach compared with another.…”

Sacroiliac Joint Fusion: One Year Clinical and Radiographic Results Following Minimally Invasive Sacroiliac Joint Fusion Surgery

“…Open fusion requires large incisions, significant bone harvesting and lengthy hospital stays [21, 30], while providing lesser improvements in pain and dysfunction than minimally-invasive (MIS) procedures [31, 33]. In comparison, MIS procedures offer improvements over open procedures and conservative treatment from both the clinical and cost-effectiveness perspectives [34, 35]. …”