Two economic publications show sacroiliac joint surgery as cost-effective and money-saving


SI-Bone has announced that two economic studies have been published which show cost benefits for minimally invasive sacroiliac (SI) joint fusion surgery in the treatment of chronic SI joint dysfunction from degenerative sacroilitis or SI joint disruption.

The first article saw researchers combine INSITE data, SIFI data and 2015 Medicare national average reimbursement data. INSITE is a prospective randomised control trial, while SIFI is a prospective single-arm trial.

This data was combined to calculate the incremental costs and health benefits of SI joint fusion vs. non-surgical management in patients with chronic SIJ dysfunction.

The purpose of the study, titled “Cost effectiveness of minimally invasive sacroiliac joint fusion,” was to calculate an incremental cost effectiveness ratio (ICER), measuring the relative cost of gains in quality of life associated with SI joint fusion.

Using a Markov model that describes health states of patients with SI joint dysfunction who undergo either surgical or non-surgical treatment, the study showed a five-year gain in quality of life of 0.74 quality-adjusted life years (QALYs) at an incremental cost of US$9,833, which corresponds to an ICER of US$13,313 per QALY gained. This ICER, when compared with the US$50,000 and US$100,000 per-QALY benchmarks commonly cited to assess treatment cost-effectiveness, was highly favourable. 

The article also compares the ICER of SI joint fusion to other interventions commonly performed by spine and orthopaedic surgeons and studied in large multicentre trials like INSITE. The ICER of SIJ fusion was lower than that of lumbar fusion for degenerative spondylolisthesis, and was closer in range to technologies considered highly cost effective, such as knee and hip arthroplasty.

In the second article, entitled “Ignoring the sacroiliac joint in chronic low back pain is costly,” David Polly and Daniel Cher analysed a cost model describing care for patients with severe chronic low back pain who are preoperative candidates for lumbar fusion. This analysis was done to address the direct cost implications of failing to consider the SI joint in the workup of chronic low back pain.

Performing lumbar fusion for patients with undiagnosed SIJ pain rather than lumbar spine problems may result in a lack of postoperative improvement in pain (since the wrong condition was treated) and worsened back pain as a result of a surgical mishap, potentially leading to failed back surgery syndrome, a disorder documented to be very costly to treat. 

In contrast, identifying and treating SI joint pain through a combination of history, physical examination and confirmatory diagnostic SI joint block, allows patients diagnosed with SI joint disruption or degenerative sacroiliitis to undergo SI joint fusion, which has high response rates as shown in a number of prospective and retrospective studies. Taking into account the additional costs of SIJ diagnosis and treatment, the cost model predicted a US$3,100 expected two-year direct healthcare cost savings when considering the SI joint compared to not considering the SI joint. Of note, this evaluated cost savings per patient.

“Shooting at the wrong target, i.e., performing surgery on the wrong body part, is clearly not in the patient’s best interest,” says David Polly. “We were interested in understanding the financial impact of failing to consider the SI joint as a potential pain generator in patients with chronic lower back pain who are seeking surgical treatments.  The results are edifying in terms of the amount of money, but perhaps not surprising given the high intensity and cost of surgical interventions.”