title: Medical cost impact of intrathecal baclofen therapy for severe spasticity.
abstract: OBJECTIVE
  To evaluate the economic effects of intrathecal baclofen (ITB) for patients with severe spasticity based on costs of care before and after implantation of an intrathecal drug delivery system.
  
  
  METHODS
  An actuarial projection of post-implant experience in the absence of ITB intervention was used to simulate a continued conventional medical management protocol (ITB-free) by assuming a reasonable trend rate based on health-care industry standards. Cost projections were developed over a 30-year time horizon at various reimplantation rates. The model was informed by retrospective analysis of commercial administrative claims data from 409 pediatric and adult spasticity patients who received a pump implant (ITB-experienced) within a 3-year service period (January 2006 to January 2009). Common indications associated with pump implant included multiple sclerosis (N = 124), cerebral palsy (N = 131), and spinal cord injury (N = 40).
  
  
  RESULTS
  ITB was less costly than the conventional protocol over our baseline implantation cycle. Costs in the month of implant and in the year following were cumulatively $26,375 more than with the conventional protocol. However, ITB financial break-even occurs between the second and third years post-implant. The lifetime analysis indicates that savings for ITB are $8009 per patient per year compared with conventional therapy. Most of the savings are derived from reductions in inpatient admissions, physician office visits, and outpatient physiotherapy.
  
  
  CONCLUSIONS
  The results suggest that spasticity patients receiving ITB would expect to experience a reduction in cumulative future medical costs relative to anticipated costs in the absence of a pump implant. This finding complements the existing literature on the cost-effectiveness of ITB.
authors.affiliation: MossRehab, Elkins Park, PA, USA.
authors.forename: Michael
authors.initials: M
authors.lastname: Saulino
authors.forename: Scott
authors.initials: S
authors.lastname: Guillemette
authors.forename: Jacqueline
authors.initials: J
authors.lastname: Leier
authors.forename: Jennifer
authors.initials: J
authors.lastname: Hinnenthal
mesh_terms: D000293:Adolescent; D000328:Adult; D017677:Age Distribution; D000368:Aged; D001418:Baclofen / Q000008:administration & dosage* / Q000191:economics*; D003362:Cost-Benefit Analysis / Q000191:economics*; D016208:Databases, Factual; D016503:Drug Delivery Systems; D005260:Female; D017048:Health Care Costs; D006801:Humans; D008297:Male; D008875:Middle Aged; D009125:Muscle Relaxants, Central / Q000008:administration & dosage* / Q000191:economics*; D009128:Muscle Spasticity / Q000188:drug therapy* / Q000191:economics; D012189:Retrospective Studies; D013997:Time Factors; D055815:Young Adult
chemical_list: D009125:Muscle Relaxants, Central; D001418:Baclofen
keywords: Cost; intrathecal; spasticity