Comparison of Healthcare Utilization Patterns between Intrathecal Drug Delivery Systems and Conventional Medical Management in the Treatment of Chronic Pain: Retrospective Study with Claims Datasets
Author(s)
Yoo YJ1, Lee H2, Choi H3, Lee SS4, Moon JY1
1Seoul National University Hospital, Seoul, Korea, Republic of (South), 2Medtronic Korea, Gangnam-gu, 41, South Korea, 3Medtronic Korea, Seoul, Korea, Republic of (South), 4Medtronic North Asia (Korea and Japan), Seoul, Korea, Republic of (South)
Presentation Documents
OBJECTIVES: Intrathecal Drug Delivery System(IDDS) has demonstrated reduction in systematic opioid consumption for the treatment of chronic pain. This study was to compare healthcare utilization patterns among non-cancer related chronic pain patients who were receiving either IDDS or Conventional Medical Management(CMM). METHODS: This was a retrospective study using the National Health Insurance Service data, a nationally representative claims dataset from 2013 to 2018. Patients were assigned to IDDS and CMM, matched 1:3 based on age, sex, Charlson Comorbidity Index and 1-year average daily morphine milligram equivalents(MME) before index date using propensity score. The daily MME, log-transformed medical expenditure, the number of ER visits and hospitalizations for the two groups were compared. As a sub-group analysis, clinical and cost-effective outcomes were assessed pre and post implantation. All datasets were checked with normality test before conducting Wilcoxon Mann-Whitney U test. RESULTS: Total of 82 patients were assigned to IDDS(n=23) or CMM(n=59) group. IDDS had a significantly lower mean daily MME compared to that of CMM group after index date at 6 months(81.57 vs. 129.13; mean difference=47.55, 95% CI -14.16-109.6, p=0.0375) and 12 months(53.17 vs. 123.88; mean difference=70.71, 95% CI 19.93-121.50, p=0.0077). Patients who underwent implantation of IDDS had significantly higher number of visits to ER at 6 months(p=0.0012) and 12 months(p<0.0001). Hospitalizations and log-transformed medical expenditure did not show significant differences between two groups. The average daily MME was significantly reduced after implantation in the sub-group analysis through the follow-up period(mean difference=41.75; 95% CI=12.76 -70.75, p=0.0068 at 6 months, 48.7; 95% CI=15.30-82.10, p=0.0067 at 12 months). Total medical expenditure was decreased at 6 months compared to pre-implantation and was statistically significant. CONCLUSIONS: IDDS implantation demonstrated significant pain relief through opioid reduction compared to CMM treatment of chronic pain patients. There was no evidence that IDDS could reduce ER visits or hospitalizations in this study.
Conference/Value in Health Info
2021-11, ISPOR Europe 2021, Copenhagen, Denmark
Value in Health, Volume 24, Issue 12, S2 (December 2021)
Code
POSB394
Topic
Clinical Outcomes, Health Service Delivery & Process of Care, Patient-Centered Research, Real World Data & Information Systems
Topic Subcategory
Comparative Effectiveness or Efficacy, Health & Insurance Records Systems, Health State Utilities, Prescribing Behavior
Disease
Drugs, Injury and Trauma, Medical Devices, Musculoskeletal Disorders
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