Targeted Drug Delivery for Cancer Pain Cuts Costs, Hospital Time
By Anne Harding
NEW YORK (Reuters Health) - Targeted drug delivery (TDD) reduces costs and healthcare utilization when added to conventional medical management (CMM) for patients with cancer-related pain, according to new findings.
Pain is commonly reported in cancer patients, including 55% of those in treatment, 39% of those in remission and 66% of those with advanced, metastatic or terminal illness, Dr. Lisa J. Stearns of the Center for Pain and Supportive Care in Phoenix, Arizona, and colleagues note in in JAMA Network Open, online April 5.
"Liberal systemic opioid use for cancer pain remains the standard of care despite increased health care utilization secondary to frequent adverse effects," they add.
TDD, which delivers opioids to the intrathecal space with an implanted infusion system and is effective at a far lower dose than systemic opioids, has been shown to improve pain relief and reduce adverse effects compared with CMM, the authors note.
This treatment approach is increasingly being provided on an outpatient basis, they add, which could reduce costs. To investigate, they reviewed MarketScan claims data on 376 patients receiving TDD plus CMM and 4,839 who had CMM alone in 2009-2015. They matched 268 patients in each group by age, sex, cancer type, comorbidity and pre-enrollment characteristics.
Mean total cost savings with TDD and CMM versus CMM only were $15,142 (P=0.01) at two months and $63,498 at one year. Cost savings at six months were $19,577, which was not a statistically significant difference.
Patients who received TDD and CMM had fewer inpatient visits and spent significantly less time in the hospital, with a mean difference of 6.8 days at two months, 6.8 days at six months and 10.6 days at 12 months.
The CMM-only group also had higher opioid use at 12 months than the TDD plus CMM group.
Medtronic, which makes pumps used for TDD, sponsored the new study, and three study authors are Medtronic employees. Several authors report paid consulting for Medtronic and other companies not related to the current research.
"The big surprise was how many fewer hospital days people had when they got a pump in and as I look over the admissions to our hospital on the cancer floors, fully two-thirds of them are for uncontrolled symptoms and pain is right up there," Dr. Thomas J. Smith of Johns Hopkins Medical Institutions in Baltimore told Reuters Health by phone.
Smith co-authored a commentary accompanying the study, and conducted a previous trial that found reduced pain, fewer adverse effects and better survival with TDD plus CMM versus CMM only for cancer pain.
He noted that patients need to survive for at least three months to fully amortize the cost of pump implantation.
"For people who have more than three months to live and are on 100 to 200 milligrams of morphine or its equivalent or who have side effects from these drugs, the oncologist should be thinking about invasive pain management," he said.
Dr. Stearns was not available for an interview by press time.
SOURCE: https://bit.ly/2Vz6TK9 and https://bit.ly/2Io1Lot
JAMA Netw Open 2019.
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