Treatment and management of sacroiliac joint pain is often non-surgical, involving packages of care that can include analgesics, physiotherapy, corticosteroid injections and radiofrequency ablation. Surgical intervention is considered when patients no longer respond to conservative management. The iFuse Implant System is placed across the sacroiliac joint using minimally invasive surgery, stabilising the joint and correcting any misalignment or weakness that can cause chronic pain. The iFuse system was evaluated in 2018 by the UK National Institute for Health and Care Excellence (NICE) as part of the Medical Technologies Evaluation Programme (MTEP). Clinical evidence for iFuse suggests improved pain, Oswestry disability index (ODI) and quality of life compared to non-surgical management. The company (SI-Bone®) submitted two cost models indicating that iFuse was cost saving compared with open surgery and non-surgical management. Clinicians advised that non-surgical management was the most appropriate comparator and Cedar (a health technology research centre) made changes to the model to test the impact of higher acquisition and procedure costs. Cedar found iFuse to be cost incurring by approximately £560 per patient at 7 years. During the consultation period, the company reduced the cost of some iFuse consumables, and Cedar extended the time horizon to test the assumption that iFuse would become cost saving over time. These changes indicated that iFuse becomes cost saving at 8 years (approximately £129 per patient), after which the cost saving continues to increase. NICE published guidance in October 2018 recommending that the case for adoption of the iFuse system in the UK National Health Service (NHS) was supported by the evidence.
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Dr Laura Knight (Cedar, Cardiff & Vale University Health Board) and Edyta Ryczek (Cedar, Cardiff & Vale University Health Board) assisted in preparation of the assessment report. We would like to thank Mr Mark Thomas (Frimley Health NHS Foundation Trust), Mr Hilali Noordeen (Royal National Orthopaedic Hospital NHS Trust), Mr Sashin Ahuja (Cardiff & Vale University Health Board) and Mr Bronek Boszczyk (University of Nottingham) for providing expert clinical advice and Mrs Kerry Bentley for providing expert patient advice. This summary of the Medical Technology Guidance was produced following the publication of the final guidance report. The article has not been externally peer reviewed by Applied Health Economics and Health Policy.
Conflict of interest
At the time of completing the assessment report, JE and HM were Cardiff University employees and had no conflict of interest. KC is a NICE employee and had no role in the production of the assessment report but contributed to the preparation of this manuscript.Cedar was funded by the NICE Medical Technologies Evaluation Programme for their work. MD, SOC and GCR are NHS employees, and the NHS has a financial interest in the guidance on which this project is based.
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Dale, M., Evans, J., Carter, K. et al. iFuse Implant System for Treating Chronic Sacroiliac Joint Pain: A NICE Medical Technology Guidance. Appl Health Econ Health Policy (2019). https://doi.org/10.1007/s40258-019-00539-7