Subject: Washington State Health Care Authority Non-coverage for Sacroiliac Joint
Fusion Surgery
Dear Mr. Morse:
On behalf of the American Association of Neurological Surgeons (AANS), the Congress of Neurological
Surgeons (CNS), the AANS/CNS Joint Section on Disorders of the Spine and Peripheral Nerves (DSPN)
and the Washington State Association of Neurological Surgeons (WSANS), we wish to express our deep
disappointment regarding the decision of the Washington State Health Care Authority (HCA) Health
Technology Assessment (HTA) program Health Technology Clinical Committee (HTCC) not to cover
sacroiliac (SI) joint fusion surgery.
We are particularly disappointed by the outcome given the fact that the Evidence Report on Sacroiliac
(SI) Joint Fusion Surgery, prepared by RTI International–University of North Carolina Evidence-based
Practice Center for consideration by the HTCC, concluded that minimally invasive SI joint fusion
procedures provide significant benefit to carefully selected patients. The evidence clearly supported
minimally invasive SI joint fusion procedures as safe and cost-effective for pain management and
improved quality of life for patients with chronic SI joint dysfunction. Furthermore, we found the literature
search and data extraction in the report to be up to date and comprehensive.
Rather than a thorough examination of the clinical evidence report prepared for the meeting, it appears
that the HTCC digressed into a discussion of revision surgery and durability, which were not part of the
evidence review. We share the concern expressed by David W. Polly, Jr., MD — who made a
presentation at the January 18, 2019, HTCC meeting on behalf of the American Academy of Orthopaedic
Surgeons (AAOS), AANS, CNS, DSPN and WSANS — that anecdotal discussion of non-operative
management for SI Joint pain was not supported by valid clinical evidence of enduring efficacy for those
treatments. Dr. Polly and the AAOS have submitted letters objecting to the decision for non-coverage,
and we agree with their comments.
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Read full letter here
