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  • EP123 Cost-effectiveness and cost-utility analyses in thailand of continuous intrathecal morphine infusion compared with conventional therapy in cancer pain: a 10-year multicenter retrospective study

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ePoster session 3 – Station 7
EP123 Cost-effectiveness and cost-utility analyses in thailand of continuous intrathecal morphine infusion compared with conventional therapy in cancer pain: a 10-year multicenter retrospective study
  1. Arpawan Thepsuwan1,
  2. Nuj Tontisirin1,
  3. Pramote Euasobhon2,
  4. Patt Pannangpetch3,
  5. Oraluck Pattanaprateep4 and
  6. Steven Cohen5
  1. 1Department of Anesthesiology, Faculty of Medicine Ramathibodi Hospital, Bangkok, Thailand
  2. 2Department of Anesthesiology, Faculty of Medicine Siriraj Hospital, Bangkok, Thailand
  3. 3Department of Anesthesiology, King Chulalongkorn Memorial Hospital, Bangkok, Thailand
  4. 4Department of clinical epidemiology and biostatistics, Faculty of Medicine Ramathibodi Hospital, Bangkok, Thailand
  5. 5Departments of Anesthesiology and Critical Care Medicine, Neurology, Physical Medicine and Rehabilitation, and Psychiatry and Behavioral Sciences, Johns Hopkins School of Medicine, Baltimore, USA

Abstract

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Background and Aims Because of the high initial cost of intrathecal drug delivery (ITDD)-therapy, this study investigated the cost-effectiveness and cost-utility of ITDD-therapy in refractory cancer pain management in Thailand over the past ten years.

Methods The retrospective study was conducted in cancer pain patients who underwent ITDD-therapy from January 2011-2021 at three university hospitals. Clinical outcomes included the numerical rating scale (NRS), Palliative Performance Scale and the European-Quality of Life Measure-5 Domain. The direct medical and non-medical, as well as indirect costs, were also recorded. Cost-effectiveness and cost-utility analyses were performed comparing ITDD-therapy with conventional therapy (interpolated from costs of the same patient before having ITDD-therapy).

Results Twenty patients (F:M: 10:10) aged 60 ± 15 years who underwent implantation of an intrathecal percutaneous port (IT-port; n =15) or programmable intrathecal pump (IT-pump; n =5) were included. The median survival time was 78 (IQR 121-54) days after ITDD therapy. At 2-month follow-up, the incremental cost-effectiveness ratio (ICER)/pain reduction of an IT port (US $862.73/NRS reduction/lifetime) was lower than for an IT-pump group (US $ 2,635.68/NRS reduction/lifetime) compared with continued conventional therapy. The ICER/quality-adjusted life years (QALY)-gained for an IT-port compared with conventional treatment was US $93,999.31/QALY-gained, which is above the cost-effectiveness threshold for Thailand.

Conclusions The cost-effectiveness and cost-utility of IT-port therapy for cancer pain was high relative to the cost of living in Thailand, above the cost-effectiveness threshold. Prospective cost-analysis studies enrolling more patients with diverse cancers that investigate the benefit of early ITDD-therapy with different-priced devices are warranted.

  • refractory cancer pain
  • cost-effectiveness analysis
  • intrathecal opioid.

https://doi.org/10.1136/rapm-2024-ESRA.196

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