Sacroiliac joint fusion health care cost comparison prior to and following surgery: An administrative claims analysis

Erin K. Buysman, Rachel Halpern, David W. Polly

Research output: Contribution to journalArticlepeer-review

1 Scopus citations

Abstract

Purpose: To assess real-world expenditures on surgical and non-surgical treatment for sacroiliac joint (SIJ) pain by comparing direct health care costs before and after surgery in patients who underwent an SIJ fusion (SIJF) procedure. Materials and methods: This retrospective observational study examined administrative claims data (January 1, 2010 to February 28, 2017) for adult commercial health plan members with a medical claim for SIJF. Identified patients were included if they had continuous enrollment in the health plan for 12 months pre-SIJF (baseline period) and 12 months post-SIJF (follow-up period). The outcomes of interest were low back pain-related health care costs in the first three quarters of the baseline period (pre-surgery period; excludes the quarter immediately preceding surgery) and last three quarters of the follow-up period (post-surgery period; excludes the quarter in which SIJF was performed). Results: Some 302 patients met inclusion criteria: 159 patients had the index SIJF in an inpatient hospital setting, 122 in an outpatient hospital setting, 18 in a surgery center, and three in other settings. Mean and median costs in the pre-surgery period were US$16,803 and US$5,849, respectively, and US$13,297 and US$2,269 in the post-surgery period. Median costs were significantly different in the pre-and post-surgery periods (P<0.001), while mean costs were not. Median health care costs in the pre-surgery and post-surgery periods were lower than the corresponding means due to the highly skewed nature of the cost data. Conclusion: This health care claims data analysis shows the potential for lower post-operative health care costs compared to pre-operative costs in patients undergoing SIJF. Median low back pain-related costs in the post-surgery period were approximately US$400 per quarter overall and US$250 per quarter for those undergoing SIJF in the non-inpatient setting. Future studies with larger sample sizes and longer follow-up will improve the precision of the cost data.

Original languageEnglish (US)
Pages (from-to)643-651
Number of pages9
JournalClinicoEconomics and Outcomes Research
Volume10
DOIs
StatePublished - 2018

Bibliographical note

Funding Information:
Funding for this study was provided by SI-BONE, Inc. Daniel Cher, MD, of SI-BONE, Inc. provided clinical expertise and conceptualization of the cross-over design for this study. Jer-ald Seare, MD, of Optum provided clinical coding expertise. Caitlin Elliott, MS, and Randall Gerdes of Optum provided data programming and analytic support. Virginia Rosen, PhD, of Optum provided editorial support in preparing the manuscript for submission.

Publisher Copyright:
© 2018 Buysman et al.

Keywords

  • Low back pain
  • Post-surgery expenditures
  • Pre-surgery expenditures

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