Cancer pain: implantable drug-delivery systems reduce healthcare use

  • Stearns LJ & al.
  • JAMA Netw Open
  • 5 Apr 2019

  • International Clinical Digest
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Takeaway

  • Adding fully implantable targeted drug delivery (TDD) to conventional medical management (CMM) to treat cancer-related pain was associated with fewer and shorter inpatient hospital stays and fewer ED visits vs CMM alone, all with a cost saving of more than $63,000/year.
  • Patients who received TDD plus CMM also had significantly fewer prescriptions for opioids, corticosteroids, and antiemetics.

Why this matters

  • Cancer-related pain, which accounts for more than 40% of ED visits, is reported in 55.0% of patients undergoing active treatment, 39.3% in remission, and 66.4% with advanced, metastatic, or terminal disease.

Study design

  • Study of 5215 patients with cancer-related pain who received CMM with or without TDD.
  • Funding: Medtronic.

Key results

  • 376 patients received TDD.
  • After propensity score matching, treatment cost was significantly less with add-on TDD vs CMM alone at 2 months (mean difference [MD], $15,142; P=.01) and 12 months (MD, $63,498; P=.03), but not at 6 months.
  • Patients receiving add-on TDD had significantly:
    • fewer inpatient hospital visits (12-month MD, 2.3; P<.001 and>
    • shorter length of stay (12-month MD, 10.6 days; P=.007).
  • Add-on TDD was associated with significantly lower prescriptions for:
    • corticosteroid (6-month MD, 0.5; P=.006),
    • antiemetic (6-month MD, 0.9; P=.02), and
    • opioid (12-month MD, 3.2; P=.03).

Limitations

  • Retrospective design.

Coauthored with Antara Ghosh, PhD