Ackerman Stacey J, Polly David W, Knight Tyler, Schneider Karen, Holt Tim, Cummings John
Covance Market Access Services Inc., San Diego, CA, USA.
University of Minnesota, Orthopaedic Surgery, Minneapolis, MN, USA.
Clinicoecon Outcomes Res. 2014 May 24;6:283-96. doi: 10.2147/CEOR.S63757. eCollection 2014.
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.
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.
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.
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.
腰痛很常见，治疗成本高昂，在劳动年龄人口中导致大量生产力损失和工资损失。起源于骶髂（SI）关节的慢性腰痛（占病例的15%-30%）通常采用非手术治疗，但新的微创手术（MIS）方法在治疗SI关节紊乱方面也很有效。我们从美国商业医保支付方的角度评估了较高的初始MIS SI关节融合手术成本是否被非手术治疗成本的降低所抵消。
一个经济模型比较了采用MIS SI关节融合或继续非手术治疗来处理SI关节紊乱的成本。非手术治疗成本（诊断测试、治疗、随访和零售药店的止痛药物）来自对Truven Health MarketScan®数据的回顾性研究。MIS融合成本基于Premier's Perspective™比较数据库以及2012年医疗保险针对当前程序编码27280的支付专业费用。
商业保险支付方面（非手术治疗成本减去MIS成本），累积3年（基础病例分析）和5年（敏感性分析）的差异分别为每位患者14,545美元和6,137美元（2012年美元）。在6年时实现了成本平衡；MIS成本主要在第1年产生，而非手术治疗成本随时间累积，到第5年时前期MIS手术成本的92%被抵消。对于接受腰椎融合手术的患者，在第1年就实现了成本平衡。
针对慢性病的新干预措施（如MIS SI关节融合）所带来的成本抵消是随时间累积的。MIS较高的初始手术成本在5年的时间范围内很大程度上被非手术治疗成本的降低所抵消。在非手术和手术患者中优化有效资源利用将有助于实现具有成本效益的医疗服务提供。SI关节紊乱对商业保险公司、健康计划受益人和雇主的直接和间接成本的影响值得进一步考虑。
