The cost-effectiveness of CT-guided sacroiliac joint injections: a measure of QALY gained

Neurol Res. 2014 Oct;36(10):915-20. doi: 10.1179/1743132814Y.0000000372. Epub 2014 Apr 28.

Abstract

Objective: The purpose of this study is to estimate the total cost and the quality of life years (QALY) gained for computer tomography (CT)-guided sacroiliac joint (SIJ) injections. The cost per QALY gained for the procedure is the primary end-point of this study.

Methods: In our 1-year prospective institutional study, we gathered 30 patients undergoing CT-guided SIJ injections for degenerative changes at the SIJ space. Patient-reported outcomes included both the US population-based EQ-5D (EuroQol) index score and the EQ-visual analog scale (VAS). The EQ-5D is based on mobility, self-care, usual activities, pain/discomfort, and anxiety depression. Utility expenditures were based on hospital charges at our institution.

Results: All 30 patients had one pre-injection physician visit followed by 43 initial injections (13 bilateral). Each patient underwent one CT scan, and three patients required additional plain films. In the 1 year following the injections, 26 physician visits were documented. Five patients required repeat CT-guided injections. Total 1-year cost for all 30 patients was $34 874·00. Mean decrease in EQ-VAS was 0·60 (P = 0·187). The mean 1-year gain of 0·58 EQ-5D QALY reached statistical significance (P < 0·001). The cost per QALY gained by CT-guided sacroiliac injections was $2004·29.

Discussion: In one of the first cost analyses of CT-guided sacroiliac injections, we found that the procedure improves pain and activities of daily living. The cost per QALY gained by CT-guided sacroiliac injections falls well below the threshold cost of 1 QALY, suggesting that the procedure is strongly cost-effective.

Keywords: CT guided,; Injections,; Joint,; Quality Adjusted Life Years (QALY); Sacroiliac,.

Publication types

  • Research Support, Non-U.S. Gov't

MeSH terms

  • Activities of Daily Living
  • Anesthetics, Local / administration & dosage*
  • Anti-Inflammatory Agents / administration & dosage*
  • Bupivacaine / administration & dosage*
  • Female
  • Humans
  • Joint Diseases / diagnostic imaging
  • Joint Diseases / drug therapy
  • Joint Diseases / economics
  • Male
  • Methylprednisolone / administration & dosage
  • Methylprednisolone / analogs & derivatives*
  • Methylprednisolone Acetate
  • Middle Aged
  • Pain Measurement
  • Prospective Studies
  • Quality-Adjusted Life Years
  • Sacroiliac Joint* / diagnostic imaging
  • Tomography, X-Ray Computed / economics
  • Tomography, X-Ray Computed / methods*
  • Treatment Outcome

Substances

  • Anesthetics, Local
  • Anti-Inflammatory Agents
  • Methylprednisolone Acetate
  • Methylprednisolone
  • Bupivacaine