Intrathecal drug delivery systems for the management of chronic non-cancer pain: a systematic review of economic evaluations

Research output: Contribution to journalReview articlepeer-review

Authors

  • Rui V Duarte
  • Tosin Lambe
  • Jon H Raphael
  • Sam Eldabe
  • Lazaros Andronis

Colleges, School and Institutes

External organisations

  • University of Liverpool
  • University of Birmingham
  • Department of Pain Management, Russells Hall Hospital, Dudley, UK.
  • Department of Pain and Anaesthesia, The James Cook University Hospital, Middlesbrough

Abstract

BACKGROUND: Intrathecal drug delivery (ITDD) systems are one of a limited number of management options for chronic non-cancer pain, cancer pain and spasticity. Concerns over their effectiveness and high initial costs led 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. The aim of this systematic review is to identify and review the existing evidence on the cost-effectiveness of ITDD for chronic non-cancer pain.

METHODS: Full and partial economic evaluations on ITDD were identified through systematic searches in MEDLINE, EMBASE, Web of Science and the National Health Service Centre for Reviews and Dissemination databases. Database searches were complemented by hand searching of reference lists of relevant studies and searches of grey literature. Study selection was carried out by two assessors, independently. Study quality assessment was performed to inform critical appraisal of health economics studies. Data were extracted using a data extraction form developed for this study.

RESULTS: 4464 unique studies were identified, of which seven met the inclusion criteria. With the exception of one study, the studies found ITDD to be either cost-saving or cost-effective compared to conventional medical management. ITDD becomes cost-ineffective in one further study following price year adjustment to 2016.

CONCLUSIONS: Study findings show ITDD as not cost-effective only in extremely conservative scenarios. There is limited evidence on the effectiveness of ITDD in non-cancer pain; however, the available economic evidence controverts arguments to refute the treatment on economic grounds. This article is protected by copyright. All rights reserved.

Details

Original languageEnglish
JournalPain Practice
Early online date24 Oct 2017
Publication statusE-pub ahead of print - 24 Oct 2017

Keywords

  • Infusion Pumps, Implantable, economic evaluations, cost effectiveness, Intrathecal