Presented at the 2012 AAPM Annual Meeting « Back

A Cost Analysis of Intrathecal Therapy for Refractory Pain in Cancer Patients

Shane Brogan, MB BCh, shane.brogan@hsc.utah.edu¹, Annalise Abiodun, BSN¹, Natalie Winter, MD¹, (1) University of Utah, Salt Lake City, Utah

Introduction: 5–10% of cancer-pain patients do not achieve satisfactory pain control or have unacceptable side effects related to pain therapies. For these refractory cancer pain patients, intrathecal therapy (ITT) is an established and superior alternative to conventional opioid use. We hypothesize that intrathecal therapy, while initially less cost effective, ultimately is more economical than conventional therapy. Materials and Methods: The University of Utah Institutional Review Board deemed this study exempt from formal review. A retrospective chart review was done on 28 patients who underwent ITT for cancer pain between January 2009 and April 2011. Data on the cost of conventional opioid therapy prior to ITT and 4–6 weeks post-implantation was collected and prorated until death. Post-ITT costs included all IT pump implantation and maintenance costs including refill medications. Results: The efficacy of ITT was calculated based on a reduction in the reporting of severe pain from 65% to 3% of patients after ITT; these results have been previously published. The average daily cost of opioid medications pre-ITT was $263.46 versus $23.85 (p = 0.01) post-ITT. The mean survival from pump implant to death was 3.5±1.9 months—the average daily pre-ITT conventional opioid use compared to the average daily costs post-ITT was $263.46 versus $331.99 (p = 0.25). Cost savings were observed in four patients with a mean survival of 10 months. Conclusions: Intrathecal therapy has greater clinical success, but is more costly than conventional management of refractory cancer pain due to higher initial costs. Greater duration of ITT therapy is associated with reduced costs. References: 1)Brogan SE: Intrathecal therapy for the management of cancer pain. Curr Pain Headache 10: 254-9, 2006.

Funding: None