(ChemotherapyAdvisor) – In selected patients with cancer pain on high-cost conventional regimens, intrathecal therapy may become cost-effective as early as seven months following implant, and greater duration of therapy is associated with reduced costs, according to results of a presentation at the American Academy of Pain Medicine 28th Annual Meeting.
Approximately 5% to 10% of patients with cancer pain “do not achieve satisfactory pain control or have unacceptable side effects related to pain therapies,” the investigators noted. They conducted a retrospective chart review of 36 patients with cancer pain who underwent intrathecal therapy and had survived more than 90 days.
Data on the cost of conventional opioid therapy prior to intrathecal implant and four to six weeks following implantation was collected and prorated until death; an assumption was made that no dose escalation occurred. Post-intrathecal therapy costs included pump implantation and maintenance costs, including refill medications.
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Pre- and post-intrathecal median daily cost of opioid medications was $124.68 vs. $6.21 (P=0.007), respectively. Median daily cost of intrathecal therapy was $14.37 for standard regimens and $28.27 when ziconotide was used. Variables associated with cost savings included pre-implant, high-cost medication such as fentanyl products, brand-name opioids, and the use of intravenous patient-controlled analgesia. Ziconotide use did not add significantly to incremental cost.
In patients with cancer pain “on high-cost opioid regimens with a favorable life-expectancy, intrathecal therapy may be preferable both from an efficacy and cost containment perspective,” they concluded.
