title: Intrathecal Morphine Infusion Therapy in Management of Chronic Pain: Present and Future Implementation in Korea.
abstract: OBJECTIVE
  Intrathecal morphine pump (ITMP) infusion therapy is efficient in managing malignant and nonmalignant chronic pain refractory to standard treatment. However, the high cost of an ITMP is the greatest barrier for starting a patient on ITMP infusion therapy. Using the revised Korean reimbursement guidelines, we investigated the cost effectiveness of ITMP infusion therapy and conducted a patient survey.
  
  
  METHODS
  A retrospective chart review of 12 patients who underwent ITMP implantation was performed. Morphine dose escalation rates were calculated, and numeric rating scale (NRS) scores were compared before and after ITMP implantation. We surveyed patients who were already using an ITMP as well as those who were candidates for an ITMP. All survey data were collected through in-person interviews over 3 months. Data on the cost of medical treatment were collected and projected over time.
  
  
  RESULTS
  The NRS score decreased during the follow-up period. The median morphine dose increased by 36.9% over the first year, and the median time required to reach a financial break-even point was 24.2 months. Patients were more satisfied with the efficacy of ITMP infusion therapy than with conventional therapy. The expected cost of ITMP implantation was KRW 4000000-5000000 in more than half of ITMP candidates scheduled to undergo implantation.
  
  
  CONCLUSIONS
  The high cost of initiating ITMP infusion therapy is challenging; however, the present results may encourage more patients to consider ITMP therapy.
authors: Department of Anesthesiology and Pain Medicine, Seoul National University Hospital, Seoul, Korea.
authors: Eun Jung
authors: EJ
authors: Kim
authors: Department of Anesthesiology and Pain Medicine, Seoul National University Hospital, Seoul, Korea.
authors: Jee Youn
authors: JY
authors: Moon
authors: Department of Anesthesiology and Pain Medicine, Seoul National University Hospital, Seoul, Korea. pain@snu.ac.kr.
authors: Yong Chul
authors: YC
authors: Kim
authors: Department of Anesthesiology and Pain Medicine, Chonnam National University Hospital, Gwangju, Korea.
authors: Keun Suk
authors: KS
authors: Park
authors: Department of Anesthesiology and Pain Medicine, Seoul National University Hospital, Seoul, Korea.
authors: Yong Jae
authors: YJ
authors: Yoo
mesh_terms: D000328:Adult; D000368:Aged; D000701:Analgesics, Opioid / Q000008:administration & dosage* / Q000191:economics / Q000627:therapeutic use; D059350:Chronic Pain / Q000188:drug therapy*; D003362:Cost-Benefit Analysis; D005260:Female; D006801:Humans; D015918:Infusion Pumps, Implantable / Q000191:economics*; D007278:Injections, Spinal; D008297:Male; D008875:Middle Aged; D009020:Morphine / Q000008:administration & dosage* / Q000191:economics / Q000627:therapeutic use; D059408:Pain Management / Q000379:methods* / Q000639:trends; D017060:Patient Satisfaction; D056910:Republic of Korea; D012189:Retrospective Studies; D011795:Surveys and Questionnaires; D016896:Treatment Outcome
chemical_list: D000701:Analgesics, Opioid; D009020:Morphine
keywords: Intrathecal; cost; morphine; survey