Longevity and Cost of Implantable Intrathecal Drug Delivery Systems for Chronic Pain Management: A Retrospective Analysis of 365 Patients

Abstract

Objectives Intrathecal drug delivery systems represent an important component of interventional strategies for refractory chronic pain syndromes. Continuous intrathecal administration of opioids results in higher subarachnoid drug concentrations, improved pain scores, and less frequent side effects when compared with systemic opioid administration. Substantial costs arise at the time of surgical implantation and at revision for battery depletion or treatment of a complication. Despite current widespread use, the real-world longevity and cost of implanted intrathecal pumps (ITP) has not been fully quantified. Materials and Methods Patients with an ITP implanted at Cleveland Clinic Pain Management Center between January 1998 and December 2012 were included. ITP longevity was calculated as the time between implant and explant for depletion of the system's battery. Using the 2013 fee schedule of the Centers for Medicare & Medicaid Services, the daily cost of having a functioning ITP was calculated. The costs of office visits for pump refills and the cost of intrathecal medications were not included, nor were the possible savings due to decreased utilization of alternate medical services. Results Three hundred sixty-five patients had 559 pumps implanted. Postlaminectomy syndrome was the most common indication (40%). The median system longevity for all pumps was 5.4 years (97.5% confidence interval: [5.0, 5.8]), including pumps extracted prematurely, as well as those that reached the elective replacement interval. The median ITP longevity was 5.9 years (95% confidence interval: [5.6, 6.1]) for pumps explanted for end of battery life. The median system cost per day was $10.46. The median cost per day of pumps explanted for end of battery life was $9.26, versus $44.59 for pumps explanted prematurely due to complications. Conclusions Overall, the cohort experienced an increased incidence of pump-related complications and a device longevity that was within the range of the manufacturer's anticipated lifespan. Increasing the lifespan of the ITP and improving patient selection have the potential to significantly improve the cost-effectiveness of intrathecal therapy.

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

“…The technical success rates of device implantation allow for fewer device explants and subsequent lower healthcare costs, with one study describing 559 implantations with 78 premature extractions (31). The premature extractions were most commonly due to infection, lack of efficacy, and surgical complications (31). The overall infection rate after implant in our practice is 0.5% and none of our survey respondents had their pumps explanted for surgical complications or lack of efficacy.…”

“…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).…”

Intrathecal Therapeutics: Device Design, Access Methods, and Complication Mitigation

“…As noted in the examples shown in Table 2 and represented schematically in Fig. 5, the spectrum of catheter-related complications reported in the literature include obstructions (29,30), positional displacements (31)(32)(33)(34), catheter coiling and engagement of the dorsal nerve rootlets (35,36), guidewire fracture (37), disconnection with the pump (38,39) or pump-related failure (40,41), infections (42,43), intrathecal granulomas and inflammatory masses (44), bradycardias due to catheter contact with the spinal cord (45), arachnoiditis (46), syrinx formation (47), and Harlequin syndrome (48). The physician most often will be faced with questions concerning surgical site infection (49) or medication under-dose or overdose.…”

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

“…Chronic pain is a major public health issue affecting 20% of the adult population worldwide [ 1 2 3 ]. The personal and socioeconomic effects of chronic pain are considered to be at least as great as those of other established healthcare priorities, including cardiovascular disease and cancer [ 4 ].…”

“…The personal and socioeconomic effects of chronic pain are considered to be at least as great as those of other established healthcare priorities, including cardiovascular disease and cancer [ 4 ]. Although it impacts quality of life in multiple functional domains, including family life, workplace performance, social interactions, and sleep patterns [ 1 2 ], less than 2% of chronic pain patients have access to a comprehensive specialist pain clinic [ 5 6 ]. The Declaration of Montreal states that pain management is inadequate across most of the world.…”