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

Abstract

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.

Pain Relief and Opioid Usage in Upper Limb and Neck Pain Patients After 10-kHz Spinal Cord Stimulation Treatment: Subanalysis of USA Studies

“…A single-center retrospective study of patients who received low-frequency SCS for refractory neuropathic pain similarly reported that baseline opioid use of ≤30 MME daily was predictive of opioid cessation and that most responders (≥50% pain relief ) did not reduce opioid use over the course of the study [28]. Likewise, a retrospective study in over 631 patients who received intrathecal drug administration for chronic, noncancer pain also found that baseline systemic opioid dose was strongly correlated with whether patients would discontinue opioid use during the following year, with those taking less than 50 MME being twofold more likely to stop opioid use than those taking 90 MME or more [29].…”

Targeted Drug Delivery for Chronic Nonmalignant Pain: Longitudinal Data From the Product Surveillance Registry

“…Guillemette et al ( 18 ), in an analysis of claims data, documented a first‐year cost increase of $17,317 for TDD compared to conventional medical management, with a break‐even point of approximately two years and a subsequent annual savings of $3111. Hatheway et al ( 19 ) analyzed commercial claims data, comparing total payer medical and pharmacy costs (reimbursed amounts) among TDD patients who discontinued systemic opioid use compared to those who did not. In this analysis, mean annual payer costs were reduced by 29% (−$11,115) for patients treated with TDD who eliminated systemic opioid use in the first year of therapy vs. patients treated with TDD who continued systemic opioids.…”

Perioperative Opioid Consumption and Clinical Outcomes in Surgical Patients With a Pre-existing Opioid-Based Intrathecal Drug Delivery System

“…[1][2][3] Concordant with these positive associations, IDDS is also associated with toxicity reduction by reducing systemic drug administration [3][4][5] as well as decreased health care utilization and total medical costs due to reduction in emergency room visits, hospitalization, and systemic opioid prescriptions. [6][7][8] Intrathecal delivery is often chosen as a route for drug delivery to reduce side effect burden for patients who cannot tolerate escalation of oral opioids. IDDS has been utilized for over 3 decades for management of cancer pain, noncancer pain, and spasticity, and is becoming increasingly more prevalent in the clinical practice of pain medicine.…”