Intrathecal Drug Delivery Systems for the Management of Chronic Noncancer Pain: A Systematic Review of Economic Evaluations

Abstract

Introduction: Intrathecal drug delivery (ITDD) systems are an option for the management of patients with chronic non-cancer pain, cancer pain and spasticity. Concerns over their invasiveness and high initial costs have led National Health Service (NHS) England to decommission ITDD for patients with chronic noncancer pain. However, the extent to which this decision is in line with existing economic evidence is unclear.To address this question, we will carry out a systematic review to identify and evaluate the existing evidence on the cost-effectiveness of ITDD for chronic non-cancer pain.Methods and analysis: A high-sensitivity search strategy will be employed in Cochrane Library, MEDLINE, EMBASE, Web of Science, NHS EED, DARE and HTA. Database searches will be complemented by additional searching techniques. Screening of the results will be performed by 2 reviewers independently using predetermined inclusion and exclusion criteria. Full and partial economic evaluations will be included. Data extraction will be carried out using a form created for the purposes of this review. Quality assessment of all included studies will be performed using recommended checklists.Ethics and dissemination: Ethical approval is not required as primary data will not be collected. Findings will be disseminated through peer-reviewed publications and conference presentations. PROSPERO registration number:CRD42016035266.

Comparison of external system and implanted system in intrathecal therapy for refractory cancer pain in China: A retrospective study

“…Despite the low maintenance cost, ITT via the implanted system is indeed a costly therapy. However, little has been reported about the cost‐effectiveness of the implanted system, compared with conventional therapy (Duarte et al., 2018 ; Ontario, 2016 ). Cost benefit is predicted at 34.2 months in the United States, 28 months in Canada, and 24.2 months in Korea (Brogan et al., 2013 ; E. J. Kim et al., 2016 ; Kumar et al., 2002 ).…”

Using economic evaluations to support acupuncture reimbursement decisions: current evidence and gaps

“…Because economic models for management of chronic pain often need to simulate at least 5 years or even a lifetime,151617 measurement of long term outcomes is crucial. Recently, published systematic reviews show that the longest follow-up of existing randomised controlled trials of acupuncture for chronic pain is 13 months 1819.…”

Intrathecal Drug Delivery Systems Survey: Trends in Utilization in Pain Practice

“…Intrathecal drug delivery systems offer a relatively safe, cost-effective, and effective mechanism of drug delivery into the CSF, thereby allowing for more efficacious improvement in pain and spasticity while also minimizing potential adverse effects when compared to other drug administration routes. 1 , 2 With the emergence of intrathecal pump therapies in the 1980s, early treatments were done with fixed continuous intrathecal infusion rates. 3 Over the last 40 years, proceduralists have adopted technical variations, divergence, and, at times, questionable intrathecal choices for medications when performing intrathecal pump trials and permanent pump therapy.…”