Assessment of Health Care Utilization and Cost of Targeted Drug Delivery and Conventional Medical Management vs Conventional Medical Management Alone for Patients With Cancer-Related Pain

Stearns, Lisa; Narang, Subina; Albright, Robert E.; Hammond, Krisstin; Xia, Ying; Richter, Heather Basara; Paramanandam, Gobi; Haagenson, Kelly K.; Doth, Alissa H.

doi:10.1001/jamanetworkopen.2019.1549

Cited by 54 publications

(33 citation statements)

References 28 publications

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“…The total reduction in payer annual expenditures associated with opioid discontinuation observed in our study was similar to the previous analysis of commercial claims data (9), when adjusted to align with the 12 months postwashout follow-up used to observe costs in the present study, and inflated to 2017 dollars (15). In another analysis of commercial claims data specific to patients with cancer-related pain, findings also suggested economic benefit among patients treated with intrathecal therapy plus conservative medical management vs. conservative medical management alone, with a significant reduction in payer all-cause costs at 12 months follow-up (mean difference $63,498, p = 0.03) (16).…”

Section: Discussionmentioning

confidence: 97%

Systemic Opioid Reduction and Discontinuation Following Implantation of Intrathecal Drug-Delivery Systems for Chronic Pain: A Retrospective Cohort Analysis

Hatheway

Bansal

Ricker

2020

Neuromodulation: Technology at the Neural Interface

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Objective: The study evaluated systemic opioid utilization before and after initiation of intrathecal drug therapy in patients with chronic, noncancer pain, as well as the effect of opioid elimination on payer costs. Methods: This was a retrospective cohort analysis of administrative claims data (2011-2016), evaluating patients using systemic opioids for chronic, noncancer pain, newly implanted with an intrathecal drug-delivery system. Patients were excluded for spasticity, cancer, and device explant. The primary outcome was reduction or discontinuation of systemic morphine milligram equivalents during a 395-day follow-up period. The secondary outcome was total commercial insurer payments. Results: Of 9223 total patients, 631 met selection criteria. From baseline to 395-day follow-up, average daily morphine milligram equivalents decreased in 81.5% of patients, and 43.3% discontinued systemic opioid therapy entirely. Among patients who continued systemic opioids, average daily morphine milligram equivalents decreased in 74.9% of patients. Logistic regression found that morphine milligram equivalents of <50 mg/day prior to initiation of intrathecal drug delivery was associated with two times the odds of discontinuation vs. ≥90 mg/day (odds ratio = 2.08, 95% confidence interval 1.42-3.02, p = 0.001). Mean annual payer costs were reduced 29% for patients who discontinued vs. continued systemic opioids (−$11,115 per patient). Conclusions: A meaningful proportion of patients discontinue or decrease systemic opioid use following initiation of intrathecal drug delivery. Standard of care should include opioid dose tapering prior to intrathecal drug delivery to maximize the probability of systemic opioid discontinuation.

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Section: Discussionmentioning

confidence: 97%

Systemic Opioid Reduction and Discontinuation Following Implantation of Intrathecal Drug-Delivery Systems for Chronic Pain: A Retrospective Cohort Analysis

Hatheway

Bansal

Ricker

2020

Neuromodulation: Technology at the Neural Interface

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“…The authors suggest that the ICD diagnosis codes for patients receiving an implant were in general rather unspecific (20). A retrospective study using MarketScan commercial claims data identified 1251 patients receiving ITDD for cancer pain between January 2009 and September 2015 (13).…”

Section: Discussionmentioning

confidence: 99%

The Unmet Need for Intrathecal Drug Delivery Pumps for the Treatment of Cancer Pain in England: An Assessment of the Hospital Episode Statistics Database

Duarte

Sale

Desai

et al. 2020

Neuromodulation: Technology at the Neural Interface

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Objectives: Intrathecal drug delivery (ITDD) devices have been shown to be a clinically effective and cost-effective option for the management of cancer pain and recommended for use in England. The aim of this study is to assess the impact of the 2015 NHS England Clinical Commissioning Policy on the uptake of ITDD pumps for the management of cancer pain or if there is an ongoing unmet need for this intervention in England. Materials and Methods: Hospital Episode Statistics (HES) were obtained for all patients undergoing ITDD for the management of cancer pain between 2014 and January 2020. In addition, HES were utilized to estimate the number of patients with cancer potentially eligible for ITDD pump during the same period. Results: The number of patients with cancer and those potentially suitable to receive an ITDD for the management of cancer pain have increased year on year since 2014. This increase has not been matched by an uptake in the provision of ITDD. Conservative estimates suggest that at least 8000 people with cancer pain would be eligible for ITDD; 458 patients received an intervention for pain management between April 2018 and March 2019 and only 30 ITDD pumps were implanted in that same period. Conclusions: We observed a substantial gap between the need and provision of ITDD for patients with refractory cancer pain in England despite the recommendation for the use of ITDD for this patient population. In addition, we present suggestions for improvement of access to and provision of ITDD in England.

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“…Technological advancements in pain pump technology (patient-controlled analgesia capability, improved catheter design, 40 cc pump reservoir) and evidence supporting the use of spinal medication admixtures (24) have had positive impacts on efficacy of TDD and subsequent improvements in physical function and quality of life (31). TDD has been shown to be a cost-effective alternative to traditional medication management of intractable chronic benign and cancer pain (31)(32)(33). With strong associations between improvement of chronic pain and its positive effect on physical function and quality of life, our results are consistent with reports of previous studies (13,18).…”

Section: Improvements In Pain Physical Function and Quality Of Lifementioning

confidence: 99%

Patient Satisfaction Following Intrathecal Targeted Drug Delivery for Benign Chronic Pain: Results of a Single-Center Survey Study

Schultz

Orhurhu

Khan

et al. 2020

Neuromodulation: Technology at the Neural Interface

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Objectives: Targeted Drug Delivery (TDD) is commonly used for the management of patients with intractable pain. Past studies have proven efficacy in pain relief and reduction in opioid use and cost-effectiveness in long-term pain management. There are few studies investigating satisfaction among patients with implanted pain pumps that are managed with targeted intrathecal medications. Material and Methods: Patients in a single medical practice implanted with pain pumps for relief of intractable pain were identified and extracted from the electronic health record (EHR). Six hundred and ten active TDD patients were identified and an anonymous 18-question survey was administered to determine satisfaction with TDD therapy. During an 18-month period from May 2018 to August 2019, patients were invited to take a satisfaction survey. Both primary and secondary outcomes were reported as proportions; P < 0.05 was considered significant. Results: Four hundred and forty-three patients (74% of the active pump population) completed the survey. The majority of patients reported improvement in pain, improvement of physical function, improvement in quality of life and reduction in opioid use. Complete discontinuation of oral opioid intake was reported in 38.9% of patients. The majority of patients had a 40 cc reservoir implanted in an upper buttock pocket site and overall, 91% of patients were happy with pump pocket location. Conclusion: Intrathecal TDD therapy can relieve pain and improve quality of life in patients with intractable pain and offers a reasonable alternative to long-term oral or skin patch opioid management. Patients utilizing TDD therapy reported high degrees of satisfaction.

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Assessment of Health Care Utilization and Cost of Targeted Drug Delivery and Conventional Medical Management vs Conventional Medical Management Alone for Patients With Cancer-Related Pain

Cited by 54 publications

References 28 publications

Systemic Opioid Reduction and Discontinuation Following Implantation of Intrathecal Drug-Delivery Systems for Chronic Pain: A Retrospective Cohort Analysis

Systemic Opioid Reduction and Discontinuation Following Implantation of Intrathecal Drug-Delivery Systems for Chronic Pain: A Retrospective Cohort Analysis

The Unmet Need for Intrathecal Drug Delivery Pumps for the Treatment of Cancer Pain in England: An Assessment of the Hospital Episode Statistics Database

Patient Satisfaction Following Intrathecal Targeted Drug Delivery for Benign Chronic Pain: Results of a Single-Center Survey Study

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