title: Intrathecal drug delivery systems for the management of chronic non-cancer pain: protocol for a systematic review of economic evaluations.
abstract: Intrathecal drug delivery (ITDD) systems are an option for the management of patients with chronic non-cancer pain, cancer pain and spasticity. Concerns over their invasiveness and high initial costs have led National Health Service (NHS) England to decommission ITDD for patients with chronic non-cancer pain. However, the extent to which this decision is in line with existing economic evidence is unclear. To address this question, we will carry out a systematic review to identify and evaluate the existing evidence on the cost-effectiveness of ITDD for chronic non-cancer pain.
  
  
  
  A high-sensitivity search strategy will be employed in Cochrane Library, MEDLINE, EMBASE, Web of Science, NHS EED, DARE and HTA. Database searches will be complemented by additional searching techniques. Screening of the results will be performed by 2 reviewers independently using predetermined inclusion and exclusion criteria. Full and partial economic evaluations will be included. Data extraction will be carried out using a form created for the purposes of this review. Quality assessment of all included studies will be performed using recommended checklists.
  
  
  
  Ethical approval is not required as primary data will not be collected. Findings will be disseminated through peer-reviewed publications and conference presentations.
  
  
  
  CRD42016035266.
authors.affiliation: Department of Public Health, Epidemiology and Biostatistics, Institute of Applied Health Research, University of Birmingham, Birmingham, UK.
authors.forename: Rui V
authors.identifier: 0000-0001-6485-7415
authors.initials: RV
authors.lastname: Duarte
authors.affiliation: Health Economics Unit, Institute of Applied Health Research, University of Birmingham, Birmingham, UK.
authors.forename: Tosin
authors.initials: T
authors.lastname: Lambe
authors.affiliation: Faculty of Health, Birmingham City University, Birmingham, UK Department of Pain Management, Russells Hall Hospital, Dudley, UK.
authors.forename: Jon H
authors.initials: JH
authors.lastname: Raphael
authors.affiliation: Department of Pain and Anaesthesia, The James Cook University Hospital, Middlesbrough, UK.
authors.forename: Sam
authors.initials: S
authors.lastname: Eldabe
authors.affiliation: Health Economics Unit, Institute of Applied Health Research, University of Birmingham, Birmingham, UK.
authors.forename: Lazaros
authors.initials: L
authors.lastname: Andronis
mesh_terms: D059350:Chronic Pain / Q000188:drug therapy*; D003362:Cost-Benefit Analysis / Q000379:methods*; D016503:Drug Delivery Systems / Q000191:economics*; D004739:England; D006801:Humans; D007278:Injections, Spinal / Q000191:economics*; D015201:Meta-Analysis as Topic; D013222:State Medicine
keywords: Chronic pain; Cost-effectiveness; Economic evaluations; Intrathecal drug delivery