title: Medical cost impact of intrathecal drug delivery for noncancer pain.
abstract: BACKGROUND
  As healthcare budgets continue to contract, there is increased payer scrutiny on the use of implantable intrathecal drug-infusion devices. This study utilizes claims data to evaluate the economic effects of intrathecal drug delivery (IDD) based on health services utilization and costs of care before and after implantation.
  
  
  METHODS
  We performed a retrospective database study involving 555 noncancer pain patients that received an IDD system implant within a 3-year service period (1/2006-1/2009). IDD patient costs were temporally aligned to implant month and repriced to a standardized, national pricing schedule over a 6-year episode cycle (3 years preimplant, implant month, and 3 years postimplant). Additionally, we made an actuarial projection of postimplant experience, in the absence of IDD intervention, simulating a conventional pain therapy (CPT) protocol by assuming the same slope in costs prior to implantation at standardized, national price levels. Cost projections were produced over a 30-year time horizon at various reimplantation rates.
  
  
  RESULTS
  IDD therapy was less costly than the CPT protocol over our baseline implantation cycle. Costs in the month of IDD implantation, and in the year following, are cumulatively $17,317 more than the CPT protocol; however, IDD financial break-even occurs soon after the second year postimplant. The lifetime analysis indicates that IDD per patient per year savings is $3,111 compared with CPT.
  
  
  CONCLUSIONS
  The authors found that patients receiving an implantable IDD system may experience reduced cumulative future medical costs relative to anticipated costs in the absence of receiving IDD. This finding complements published literature on the cost-effectiveness of IDD.
authors.affiliation: OptumInsight, Eden Prairie, MN 55344-7302, USA. scott.guillemette@optum.com
authors.forename: Scott
authors.initials: S
authors.lastname: Guillemette
authors.forename: Susan
authors.initials: S
authors.lastname: Witzke
authors.forename: Jacqueline
authors.initials: J
authors.lastname: Leier
authors.forename: Jennifer
authors.initials: J
authors.lastname: Hinnenthal
authors.forename: Joshua P
authors.initials: JP
authors.lastname: Prager
mesh_terms: D000328:Adult; D000368:Aged; D000701:Analgesics, Opioid / Q000008:administration & dosage / Q000191:economics* / Q000627:therapeutic use*; D003365:Costs and Cost Analysis; D016208:Databases, Factual; D004343:Drug Implants / Q000191:economics; D005260:Female; D006801:Humans; D015918:Infusion Pumps, Implantable / Q000191:economics*; D007278:Injections, Spinal / Q000191:economics*; D038801:International Classification of Diseases; D008297:Male; D008875:Middle Aged; D010146:Pain / Q000188:drug therapy* / Q000191:economics*; D059408:Pain Management / Q000191:economics*; D012189:Retrospective Studies; D055815:Young Adult
chemical_list: D000701:Analgesics, Opioid; D004343:Drug Implants