Intrathecal Morphine Infusion Therapy in Management of Chronic Pain: Present and Future Implementation in Korea

Abstract

PurposeIntrathecal morphine pump (ITMP) infusion therapy is efficient in managing malignant and nonmalignant chronic pain refractory to standard treatment. However, the high cost of an ITMP is the greatest barrier for starting a patient on ITMP infusion therapy. Using the revised Korean reimbursement guidelines, we investigated the cost effectiveness of ITMP infusion therapy and conducted a patient survey.Materials and MethodsA retrospective chart review of 12 patients who underwent ITMP implantation was performed. Morphine dose escalation rates were calculated, and numeric rating scale (NRS) scores were compared before and after ITMP implantation. We surveyed patients who were already using an ITMP as well as those who were candidates for an ITMP. All survey data were collected through in-person interviews over 3 months. Data on the cost of medical treatment were collected and projected over time.ResultsThe NRS score decreased during the follow-up period. The median morphine dose increased by 36.9% over the first year, and the median time required to reach a financial break-even point was 24.2 months. Patients were more satisfied with the efficacy of ITMP infusion therapy than with conventional therapy. The expected cost of ITMP implantation was KRW 4000000–5000000 in more than half of ITMP candidates scheduled to undergo implantation.ConclusionThe high cost of initiating ITMP infusion therapy is challenging; however, the present results may encourage more patients to consider ITMP therapy.

<p>Intrathecal Morphine Infusion Therapy via a Percutaneous Port for Refractory Cancer Pain in China: An Efficacy, Safety and Cost Utilization Analysis</p>

“…An interval of 334 months was required to reach cost equivalence in cancer patients with intrathecal morphine infusion therapy via an implanted morphine pump in the USA, while the interval was 24.2 months in Korea and 28 months for chronic low back pain in Canada. [10][11][12] Based on our results, IMITPP may become cost-beneficial at a shorter interval (11.44 months) than intrathecal morphine infusion therapy via an implanted morphine pump, profiting Figure 4 Interval required to achieve cost equivalence among different pre-IMITPP oral morphine equivalent dose (OMED) groups. N=19 for RD group, n=14 for HD group, and n=10 for VHD group.…”

“…4 In the present study, most of the drug-related adverse events were controlled by symptomatic treatments and generally subsided within a few days, which is in accordance with other studies. 11,22 It is notable that severe diarrhea was reported in two patients after conversion from systemic opioids to intrathecal morphine, which was reversed by deceleration of decreased speed of systemic opioids dosage, but not by symptomatic treatment. We considered diarrhea as a gastrointestinal withdrawal symptom associated with systemic opioids withdrawal in the two patients.…”

“…7,8 Previous reports on cost effectiveness suggested different intervals for cost equivalence from 19 to 344 months between intrathecal morphine infusion therapy via an implanted morphine pump and conventional medicine therapy depending on different countries or regions. 4,[9][10][11][12] Intrathecal morphine infusion therapy via a percutaneous port (IMITPP) is expected to take a shorter time to reach cost equivalence than intrathecal morphine infusion therapy via an implanted morphine pump because of its relatively lower initial implantation costs, which would be a better choice for the advanced cancer patients with short life expectancy. 3,4 However, there is a lack of knowledge about intervals for cost equivalence between IMITPP and conventional medical therapy.…”

Long-term morphine delivery via slow release morphine pellets or osmotic pumps: Plasma concentration, analgesia, and naloxone-precipitated withdrawal

“…In the clinical setting, morphine and other opiates are generally available as acute injections, oral and buccal tablets [35,36], and intrathecal and intracerebrovascular pumps [37,38]. After a 10 mg/kg intravenous dosage of morphine, humans had an average plasma AUC 0–12 of 91.9±6.3 ng·hr/mL [36].…”

Retrospective analysis of the financial break-even point for intrathecal morphine pump use in Korea

“…A previous study in eleven patients with non-cancer pain and one cancer patient that underwent IDD pump therapy in Korea indicated that the median time required to reach the financial break-even point was 24.2 months [ 12 ]. The new NHI reimbursement policy may promote wider use of IDD as a treatment option for chronic pain patients in Korea, which would affect the financial break-even point in Korean patients.…”