title: Health Services Utilization and Payments in Patients With Cancer Pain: A Comparison of Intrathecal Drug Delivery vs. Conventional Medical Management.
abstract: BACKGROUND
  To compare health services utilization and payments for cancer patients who received an implantable intrathecal drug delivery (IDD) system, consisting of a pump and catheter, vs. conventional medical management (CMM) for the treatment of cancer-related pain.
  
  
  METHODS
  This retrospective claims-data analysis compared health services utilization and payments in a population of patients receiving either IDD or CMM for treatment of cancer pain. Patients were propensity score-matched 1:1 based on characteristics including, but not limited to, age, gender, cancer type, comorbid conditions, and health care utilization and payments.
  
  
  RESULTS
  From a sample of 142 IDD patients and 3188 CMM patients who met all inclusion/exclusion criteria, 73 matched pairs were obtained. In the year following implant, IDD patients had a consistent trend of lower medical utilization, and total payments that were $3195 lower compared to CMM.
  
  
  CONCLUSIONS
  Despite the high initial cost of IDD, this analysis suggests that patients with IDD incur lower medical utilization and payments over the first year post-implant. Further analysis comprised of a larger, longitudinal sample would contribute to health economics and outcomes research, and assist with future practice guideline development.
authors.affiliation: Arizona Center for Pain and Supportive Care, Phoenix, AZ, USA.
authors.forename: Lisa J
authors.initials: LJ
authors.lastname: Stearns
authors.affiliation: Neuromodulation, Medtronic, Inc., Minneapolis, MN, USA.
authors.forename: Jennifer A
authors.initials: JA
authors.lastname: Hinnenthal
authors.affiliation: Arizona Center for Pain and Supportive Care, Phoenix, AZ, USA.
authors.forename: Krisstin
authors.initials: K
authors.lastname: Hammond
authors.affiliation: Arizona Center for Pain and Supportive Care, Phoenix, AZ, USA.
authors.forename: Eric
authors.initials: E
authors.lastname: Berryman
authors.affiliation: National Center for Policy Analysis, Dallas, TX, USA.
authors.forename: Nora A
authors.initials: NA
authors.lastname: Janjan
mesh_terms: D000328:Adult; D000368:Aged; D000700:Analgesics / Q000008:administration & dosage*; D005260:Female; D006801:Humans; D015918:Infusion Pumps, Implantable / Q000191:economics*; D007278:Injections, Spinal / Q000191:economics / Q000379:methods; D008297:Male; D008875:Middle Aged; D009369:Neoplasms / Q000150:complications*; D010146:Pain / Q000209:etiology; D059408:Pain Management / Q000191:economics* / Q000379:methods; D010342:Patient Acceptance of Health Care; D057216:Propensity Score; D012189:Retrospective Studies
chemical_list: D000700:Analgesics
keywords: Cancer pain; conventional medical management; health services utilization; intrathecal drug delivery; retrospective study
references.citation: Health Aff (Millwood). 2015 Jan;34(1):150-60
references.pmid: 25472958
references.citation: J Cancer Surviv. 2007 Jun;1(2):167-75
references.pmid: 18648958
references.citation: Surg Neurol. 1999 Jan;51(1):6-11
references.pmid: 9952116
references.citation: J Support Oncol. 2005 Nov-Dec;3(6):399-408
references.pmid: 16350425
references.citation: Eur J Pain. 2012 Feb;16(2):289-99
references.pmid: 22323381
references.citation: J Neurosurg. 1990 Sep;73(3):405-9
references.pmid: 2384779
references.citation: Am J Manag Care. 2003 Oct;9(10):651-64
references.pmid: 14572175
references.citation: JAMA. 2004 Jan 7;291(1):63-70
references.pmid: 14709577
references.citation: J Clin Oncol. 2002 Oct 1;20(19):4040-9
references.pmid: 12351602
references.citation: J Natl Cancer Inst. 2011 Jan 19;103(2):117-28
references.pmid: 21228314
references.citation: J Clin Nurs. 2003 Sep;12(5):726-35
references.pmid: 12919219
references.citation: Cancer. 2011 Jun 15;117(12):2779-90
references.pmid: 21495026