The cost-effectiveness of CT-guided sacroiliac joint injections: a measure of QALY gained.
OBJECTIVE
The purpose of this study is to estimate the total cost and the quality of life years (QALY) gained for computer tomography (CT)-guided sacroiliac joint (SIJ) injections. The cost per QALY gained for the procedure is the primary end-point of this study.


METHODS
In our 1-year prospective institutional study, we gathered 30 patients undergoing CT-guided SIJ injections for degenerative changes at the SIJ space. Patient-reported outcomes included both the US population-based EQ-5D (EuroQol) index score and the EQ-visual analog scale (VAS). The EQ-5D is based on mobility, self-care, usual activities, pain/discomfort, and anxiety depression. Utility expenditures were based on hospital charges at our institution.


RESULTS
All 30 patients had one pre-injection physician visit followed by 43 initial injections (13 bilateral). Each patient underwent one CT scan, and three patients required additional plain films. In the 1 year following the injections, 26 physician visits were documented. Five patients required repeat CT-guided injections. Total 1-year cost for all 30 patients was $34 874·00. Mean decrease in EQ-VAS was 0·60 (P  =  0·187). The mean 1-year gain of 0·58 EQ-5D QALY reached statistical significance (P < 0·001). The cost per QALY gained by CT-guided sacroiliac injections was $2004·29.


CONCLUSIONS
In one of the first cost analyses of CT-guided sacroiliac injections, we found that the procedure improves pain and activities of daily living. The cost per QALY gained by CT-guided sacroiliac injections falls well below the threshold cost of 1 QALY, suggesting that the procedure is strongly cost-effective.
Mohamad
M
Bydon
Mohamed
M
Macki
Rafael
R
De la Garza-Ramos
Mina
M
Youssef
Ziya L
ZL
Gokaslan
Sherif
S
Meleka
Ali
A
Bydon
D000203:Activities of Daily Living; D000779:Anesthetics, Local / Q000008:administration & dosage*; D000893:Anti-Inflammatory Agents / Q000008:administration & dosage*; D002045:Bupivacaine / Q000008:administration & dosage*; D005260:Female; D006801:Humans; D007592:Joint Diseases / Q000000981:diagnostic imaging / Q000188:drug therapy / Q000191:economics; D008297:Male; D008775:Methylprednisolone / Q000008:administration & dosage / Q000031:analogs & derivatives*; D000077555:Methylprednisolone Acetate; D008875:Middle Aged; D010147:Pain Measurement; D011446:Prospective Studies; D019057:Quality-Adjusted Life Years; D012446:Sacroiliac Joint / Q000000981:diagnostic imaging; D014057:Tomography, X-Ray Computed / Q000191:economics / Q000379:methods*; D016896:Treatment Outcome
D000779:Anesthetics, Local; D000893:Anti-Inflammatory Agents; D000077555:Methylprednisolone Acetate; D008775:Methylprednisolone; D002045:Bupivacaine
CT guided,; Injections,; Joint,; Quality Adjusted Life Years (QALY); Sacroiliac,