title: Longevity and cost of implantable intrathecal drug delivery systems for chronic pain management: a retrospective analysis of 365 patients.
abstract: OBJECTIVE
  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.
  
  
  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.
authors.affiliation: Department of Pain Management, Cleveland Clinic, Cleveland, OH, USA.
authors.forename: Robert
authors.initials: R
authors.lastname: Bolash
authors.forename: Belinda
authors.initials: B
authors.lastname: Udeh
authors.forename: Youssef
authors.initials: Y
authors.lastname: Saweris
authors.forename: Maged
authors.initials: M
authors.lastname: Guirguis
authors.forename: Jarrod E
authors.initials: JE
authors.lastname: Dalton
authors.forename: Natalya
authors.initials: N
authors.lastname: Makarova
authors.forename: Nagy
authors.initials: N
authors.lastname: Mekhail
mesh_terms: D000328:Adult; D000368:Aged; D000701:Analgesics, Opioid / Q000008:administration & dosage* / Q000191:economics*; D059350:Chronic Pain / Q000188:drug therapy*; D005260:Female; D006801:Humans; D015918:Infusion Pumps, Implantable / Q000191:economics*; D053208:Kaplan-Meier Estimate; D008137:Longitudinal Studies; D008297:Male; D008875:Middle Aged; D059408:Pain Management / Q000191:economics* / Q000379:methods; D010147:Pain Measurement; D012189:Retrospective Studies; D016896:Treatment Outcome
chemical_list: D000701:Analgesics, Opioid
keywords: Adverse events; chronic pain; complications; cost of therapy; indications; intrathecal drug delivery; intrathecal pump; intrathecal pump longevity