#57 Sacroiliac Joint Disruption Managed with Non-operative Care Is Costly to Commercial Payers
Poster Presented by: T.A. Holt
S.J. Ackerman (1)
T.A. Holt (2)
T. Knight (3)
J. Cummings (4)
D.W. Polly, Jr (5)
(1) Covance Market Access Inc., San Diego, CA, United States
(2) Montgomery Spine Center, Orthopaedic Surgery, Montgomery, AL, United States
(3) Covance Market Access Inc., Gaithersburg, MD, United States
(4) Community Health Network, Neurosurgery, Indianapolis, IN, United States
(5) University of Minnesota, Orthopaedic Surgery, Minneapolis, MN, United States
Introduction: Low back pain is common and increasing in prevalence with 70%-80% of adults in the US experiencing low back pain sometime during their lives. Low back pain originates in the sacroiliac (SI) joint in 15%-30% of cases. SI joint disruption/degenerative sacroiliitis treatments have traditionally included non-operative medical management or open SI joint fusion, which requires a several day inpatient stay. Newly developed minimally-invasive technologies to treat SI joint disruption/degenerative sacroiliitis have been shown to be safe and effective. In order to evaluate the usefulness of these new techniques, the costs of SI joint disruption/degenerative sacroiliitis treatment among privately-insured patients must be understood. We assessed the health resource utilization and costs of non-operative care for SI joint disruption/degenerative sacroiliitis to commercial payers.
Methods: We conducted a retrospective study of claims-level medical resource use and associated costs to commercial payers using the MarketScan® Commercial Claims and Encounters and Medicare Supplemental Databases of Truven Healthcare. Patients with a primary International Classification of Diseases, Ninth Revision, Clinical Modification (ICD-9-CM) diagnosis code for SI joint disruption/degenerative sacroiliitis (ICD-9-CM diagnosis codes 720.2, 724.6, 739.4, 846.9, or 847.3) with an initial date of diagnosis 1/1/2005-12/31/2007 (index date) were included. Patients were required to have continuous medical and pharmacy enrollment for ≥ 1 year before and 3 years after the index date. Within this population, claims attributable to SI joint disruption/degenerative sacroiliitis were identified using claims with a primary or secondary ICD-9-CM diagnosis code of 71x.xx, 72x.xx, 73x.xx, or 84x.xx, and the 3-year medical resource use and associated reimbursement (in 2011 US dollars), and outpatient pain medication costs were tabulated across practice settings. A subgroup analysis was performed among patients who underwent lumbar spinal fusion.
Results: The mean 3-year cumulative direct medical costs (2011 USD) attributable to SI joint disruption/degenerative sacroiliitis was $16,196 (SD $28,592) per privately-insured patient (N = 78,533). Among the subgroup of patients who underwent lumbar spinal fusion (N = 454), the attributable 3-year costs were $91,720 (SD $75,502) per patient compared to $15,776 (SD $27,542) among the subgroup of patients who had not undergone lumbar spinal fusion (N = 78,099). For the total population, inpatient hospitalizations (19.4%), hospital outpatient visits and procedures (14.0%), and outpatient pain medications (9.6%) accounted for the largest proportion of costs. Over the 3-year period the insurance payments attributable to SI joint disruption/degenerative sacroiliitis were estimated to be $1.6 billion per 100,000 commercial payer beneficiaries diagnosed with SI joint disruption/degenerative sacroiliitis.
Conclusion: This retrospective commercial claims analysis demonstrates that the healthcare resource utilization and attributable costs of non-operative care for patients with SI joint disruption/degenerative sacroiliitis are substantial. The annual per patient economic burden of SI joint disruption (mean attributable cost of $5,399 per year over the three years following initial diagnosis) is similar to chronic low back pain (estimated at $5,254 per year) and greater than hypertension (estimated at $1,659 per year). The economic burden of SI joint disruption and degenerative sacroiliitis among privately-insured patients in the US highlights the need for more cost-effective therapies to treat this condition and reduce healthcare expenditures.