title: 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: BACKGROUND
  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.
  
  
  CONCLUSIONS
  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.
authors.affiliation: Covance Market Access Services Inc., San Diego, CA, USA.
authors.forename: Stacey J
authors.initials: SJ
authors.lastname: Ackerman
authors.affiliation: University of Minnesota, Orthopaedic Surgery, Minneapolis, MN, USA.
authors.forename: David W
authors.initials: DW
authors.lastname: Polly
authors.affiliation: Covance Market Access Services Inc., Gaithersburg, MD, USA.
authors.forename: Tyler
authors.initials: T
authors.lastname: Knight
authors.affiliation: Covance Market Access Services Inc., Sydney, Australia.
authors.forename: Karen
authors.initials: K
authors.lastname: Schneider
authors.affiliation: Montgomery Spine Center, Orthopedic Surgery, Montgomery, AL, USA.
authors.forename: Tim
authors.initials: T
authors.lastname: Holt
authors.affiliation: Community Health Network, Neurosurgery, Indianapolis, IN, USA.
authors.forename: John
authors.initials: J
authors.lastname: Cummings
keywords: economic model; epidural injection; iFuse; insurance; sacroiliac joint fusion; sacroiliac joint pain