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Minimally Invasive Sacroiliac Joint Fusion with Triangular Titanium Implants: Cost-Utility Analysis from NHS Perspective

OBJECTIVE: The aim was to identify the cost-effectiveness of minimally invasive sacroiliac joint fusion (MI SIJF) surgery with titanium triangular implants for patients with sacroiliac joint (SIJ) pain who have failed conservative management, compared to non-surgical management (NSM) from a National...

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Autores principales: Blissett, Deirdre B., Blissett, Rob S., Ede, Matthew P. Newton, Stott, Philip M., Cher, Daniel J., Reckling, W. Carlton
Formato: Online Artículo Texto
Lenguaje:English
Publicado: Springer International Publishing 2020
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8160075/
https://www.ncbi.nlm.nih.gov/pubmed/33165824
http://dx.doi.org/10.1007/s41669-020-00236-5
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author Blissett, Deirdre B.
Blissett, Rob S.
Ede, Matthew P. Newton
Stott, Philip M.
Cher, Daniel J.
Reckling, W. Carlton
author_facet Blissett, Deirdre B.
Blissett, Rob S.
Ede, Matthew P. Newton
Stott, Philip M.
Cher, Daniel J.
Reckling, W. Carlton
author_sort Blissett, Deirdre B.
collection PubMed
description OBJECTIVE: The aim was to identify the cost-effectiveness of minimally invasive sacroiliac joint fusion (MI SIJF) surgery with titanium triangular implants for patients with sacroiliac joint (SIJ) pain who have failed conservative management, compared to non-surgical management (NSM) from a National Health Service (NHS) England perspective. METHODS: Over a time horizon of 5 years, a cohort state transition model compared the costs and outcomes of treating patients with MI SIJF to those of traditional NSM treatment pathways. The NSM arm included two treatments: grouped physical therapy and corticosteroid injections (PTSI) or radiofrequency ablation (RFA). Three different strategies were considered: (1) a stepped pathway, (2) patients split between PTSI and RFA, and (3) RFA only. The outcome measure was incremental cost-effectiveness ratio (ICER), reported in 2018 British pounds per quality-adjusted life year (QALY) gained. One-way and probabilistic sensitivity analyses were used to test the robustness of the model results. RESULTS: Patients undergoing MI SIJF accrued total procedure-related and pain-management costs of £8358, while NSM treatment strategy 1 had total costs of £6880. The MI SIJF cohort had 2.98 QALYs compared to strategy 1 with 2.30 QALYs. This resulted in an ICER for MI SIJF versus strategy 1 of £2164/QALY gained. Strategy 2 of the NSM arm had lower costs than strategy 1 (£6564) and 2.26 QALYs, and this resulted in an ICER of £2468/QALY gained for MI SIJF. Strategy 3 of the NSM arm had lower costs than strategy 1 (£6580), and this resulted in 2.28 QALYs and an ICER of £2518/QALY gained for MI SIJF. Probabilistic sensitivity analysis shows that at a threshold of £20,000/QALY gained, MI SIJF has a probability of being cost-effective versus NSM strategies of 96%, 97%, and 91% for strategies 1, 2, and 3, respectively. CONCLUSION: MI SIJF appears to be cost-effective over a 5-year time horizon when compared to traditional NSM pathways in an NHS context. ELECTRONIC SUPPLEMENTARY MATERIAL: The online version of this article (10.1007/s41669-020-00236-5) contains supplementary material, which is available to authorized users.
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spelling pubmed-81600752021-06-17 Minimally Invasive Sacroiliac Joint Fusion with Triangular Titanium Implants: Cost-Utility Analysis from NHS Perspective Blissett, Deirdre B. Blissett, Rob S. Ede, Matthew P. Newton Stott, Philip M. Cher, Daniel J. Reckling, W. Carlton Pharmacoecon Open Original Research Article OBJECTIVE: The aim was to identify the cost-effectiveness of minimally invasive sacroiliac joint fusion (MI SIJF) surgery with titanium triangular implants for patients with sacroiliac joint (SIJ) pain who have failed conservative management, compared to non-surgical management (NSM) from a National Health Service (NHS) England perspective. METHODS: Over a time horizon of 5 years, a cohort state transition model compared the costs and outcomes of treating patients with MI SIJF to those of traditional NSM treatment pathways. The NSM arm included two treatments: grouped physical therapy and corticosteroid injections (PTSI) or radiofrequency ablation (RFA). Three different strategies were considered: (1) a stepped pathway, (2) patients split between PTSI and RFA, and (3) RFA only. The outcome measure was incremental cost-effectiveness ratio (ICER), reported in 2018 British pounds per quality-adjusted life year (QALY) gained. One-way and probabilistic sensitivity analyses were used to test the robustness of the model results. RESULTS: Patients undergoing MI SIJF accrued total procedure-related and pain-management costs of £8358, while NSM treatment strategy 1 had total costs of £6880. The MI SIJF cohort had 2.98 QALYs compared to strategy 1 with 2.30 QALYs. This resulted in an ICER for MI SIJF versus strategy 1 of £2164/QALY gained. Strategy 2 of the NSM arm had lower costs than strategy 1 (£6564) and 2.26 QALYs, and this resulted in an ICER of £2468/QALY gained for MI SIJF. Strategy 3 of the NSM arm had lower costs than strategy 1 (£6580), and this resulted in 2.28 QALYs and an ICER of £2518/QALY gained for MI SIJF. Probabilistic sensitivity analysis shows that at a threshold of £20,000/QALY gained, MI SIJF has a probability of being cost-effective versus NSM strategies of 96%, 97%, and 91% for strategies 1, 2, and 3, respectively. CONCLUSION: MI SIJF appears to be cost-effective over a 5-year time horizon when compared to traditional NSM pathways in an NHS context. ELECTRONIC SUPPLEMENTARY MATERIAL: The online version of this article (10.1007/s41669-020-00236-5) contains supplementary material, which is available to authorized users. Springer International Publishing 2020-11-09 /pmc/articles/PMC8160075/ /pubmed/33165824 http://dx.doi.org/10.1007/s41669-020-00236-5 Text en © The Author(s) 2020 https://creativecommons.org/licenses/by-nc/4.0/Open AccessThis article is licensed under a Creative Commons Attribution-NonCommercial 4.0 International License, which permits any non-commercial use, sharing, adaptation, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons licence, and indicate if changes were made. The images or other third party material in this article are included in the article's Creative Commons licence, unless indicated otherwise in a credit line to the material. If material is not included in the article's Creative Commons licence and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder. To view a copy of this licence, visit http://creativecommons.org/licenses/by-nc/4.0/ (https://creativecommons.org/licenses/by-nc/4.0/) .
spellingShingle Original Research Article
Blissett, Deirdre B.
Blissett, Rob S.
Ede, Matthew P. Newton
Stott, Philip M.
Cher, Daniel J.
Reckling, W. Carlton
Minimally Invasive Sacroiliac Joint Fusion with Triangular Titanium Implants: Cost-Utility Analysis from NHS Perspective
title Minimally Invasive Sacroiliac Joint Fusion with Triangular Titanium Implants: Cost-Utility Analysis from NHS Perspective
title_full Minimally Invasive Sacroiliac Joint Fusion with Triangular Titanium Implants: Cost-Utility Analysis from NHS Perspective
title_fullStr Minimally Invasive Sacroiliac Joint Fusion with Triangular Titanium Implants: Cost-Utility Analysis from NHS Perspective
title_full_unstemmed Minimally Invasive Sacroiliac Joint Fusion with Triangular Titanium Implants: Cost-Utility Analysis from NHS Perspective
title_short Minimally Invasive Sacroiliac Joint Fusion with Triangular Titanium Implants: Cost-Utility Analysis from NHS Perspective
title_sort minimally invasive sacroiliac joint fusion with triangular titanium implants: cost-utility analysis from nhs perspective
topic Original Research Article
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8160075/
https://www.ncbi.nlm.nih.gov/pubmed/33165824
http://dx.doi.org/10.1007/s41669-020-00236-5
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