Cost-effectiveness of minimally invasive sacroiliac joint fusion

Daniel J Cher,1 Melissa A Frasco,2 Ren&eacute;e JG Arnold,2,3 David W Polly4,5 1Clinical Affairs, SI-BONE, Inc., San Jose, CA, USA; 2Division of Health Economics and Outcomes Research, Quorum Consulting, Inc., San Francisco, CA, USA; 3Department of Preventive Medicine, Icahn School of Medicine at Mount Sinai, New York, NY, USA; 4Department of Orthopaedic Surgery, University of Minnesota, Minneapolis, MN, USA; 5Department of Neurosurgery, University of Minnesota, Minneapolis, MN, USA Background: Sacroiliac joint (SIJ) disorders are common in patients with chronic lower back pain. Minimally invasive surgical options have been shown to be effective for the treatment of chronic SIJ dysfunction. Objective: To determine the cost-effectiveness of minimally invasive SIJ fusion. Methods: Data from two prospective, multicenter, clinical trials were used to inform a Markov process cost-utility model to evaluate cumulative 5-year health quality and costs after minimally invasive SIJ fusion using triangular titanium implants or non-surgical treatment. The analysis was performed from a third-party perspective. The model specifically incorporated variation in resource utilization observed in the randomized trial. Multiple one-way and probabilistic sensitivity analyses were performed. Results: SIJ fusion was associated with a gain of approximately 0.74 quality-adjusted life years (QALYs) at a cost of US13,313 per QALY gained. In multiple one-way sensitivity analyses all scenarios resulted in an incremental cost-effectiveness ratio (ICER) <26,000/QALY. Probabilistic analyses showed a high degree of certainty that the maximum ICER for SIJ fusion was less than commonly selected thresholds for acceptability (mean ICER =$13,687, 95$5,162&ndash;$28,085). SIJ fusion provided potential cost savings per QALY gained compared to non-surgical treatment after a treatment horizon of greater than 13 years. Conclusion: Compared to traditional non-surgical treatments, SIJ fusion is a cost-effective, and, in the long term, cost-saving strategy for the treatment of SIJ dysfunction due to degenerative sacroiliitis or SIJ disruption. Keywords: cost-effectiveness analysis, degenerative sacroiliitis, minimally invasive surgery, sacroiliac joint arthrodesis, sacroiliac joint disruptions, sacroiliac joint dysfunction, spine surger

Cost-effectiveness of minimally invasive sacroiliac joint fusion [Corrigendum]

Cher DJ, Frasco MA, Arnold RJ, Polly DW. Clinicoecon Outcomes Res. 2016;8:1&ndash;14.Daniel J Cher is an SI-BONE employee. Renee JG Arnold and Melissa A Frasco are employees of Quorum Consulting, hired by SI-BONE to help prepare and evaluate the cost-utility model. David Polly is an investigator in clinical research studies sponsored by SI-BONE but has no financial interest in the company. The authors report no other conflicts of interest in this work.View original article by Cher et al