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Targeted drug delivery reduces costs for management of cancer-related pain
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Targeted drug delivery in combination with conventional medical management significantly reduced costs and health care utilization compared with conventional medical management alone for patients with cancer pain, according to results of a retrospective study published in JAMA.
The findings support use of targeted drug delivery among patients with cancer who experience intolerable adverse events or inadequate pain relief from oral opioids, according to the researchers.
“[Targeted drug delivery] should be considered as an option for patients with cancer-related pain,” Lisa J. Stearns, MD, founder and medical director of Center for Pain and Supportive Care in Phoenix, said in a press release. “It is proven safe and effective for [patients with] cancer pain, offering pain relief and improvements in quality of life. Now, [targeted drug delivery] also demonstrates a robust financial benefit, which is especially significant as the incidence and societal burden of cancer continues to increase.”
The NCI estimates that the annual cost of cancer treatment in the United States will reach $157 billion in 2020, up from $125 billion in 2010. The rising cost is fueled by a 30% increase in cancer survivorship and an aging U.S. population.
Pain accounts for about 41% of ED visits by patients with cancer, although it has been identified as a preventable cause for hospital admissions.
Systemic opioid use remains the standard of care for cancer pain. Targeted drug delivery, however, offers an alternative, allowing physicians to prescribe reduced doses of medication that are delivered directly to the fluid around the spinal cord through an implantable pump.
Stearns and colleagues analyzed costs of the treatment options for cancer-related pain in a matched, retrospective cohort study of 268 patients (mean age, 51.9 years; 57.1% women) who received targeted drug delivery and conventional medical management and 268 patients (mean age, 52.2 years; 56.7% women) who received conventional medical management only.
Total costs at 2 months, 6 months and 12 months, number of health care encounters, hospital stay length, other cost components and health care utilization served as primary outcome measures.
At 12 months, 90 patients receiving the combination and 98 patients receiving conventional medical management only remained in the study.
Results showed that the use of targeted drug delivery yielded a mean cost savings of $15,142 (95% CI, 3,690-26,594; P = .01) at 2 months and $63,498 (95% CI, 4,620-122,376; P = .03) at 12 months. Savings at 6 months were not statistically significant.
The combination also resulted in fewer inpatient visits at 2 months (mean difference [MD], 1; 95% CI, 0.8-1.2; P < .001), 6 months (MD, 1.3; 95% CI, 0.8-1.7; P < .001) and 12 months (MD, 2.3; 95% CI, 1.2-3.4; P < .001) and with shorter hospital stays at 2 months (MD, 6.8 days; 95% CI, 5-8.7; P < .001), 6 months (MD, 6.8 days; 95% CI, 3.1-10.5; P < .001), and 12 months (MD, 10.6 days; 95% CI, 2.9-18.3; P = .007).
Use of conventional medical management only was associated with a higher use of opioids at 12 months (MD, 3.2; 95% CI, 0.4-6; P = .003).
Researchers obtained data on health care utilization and costs from Truven Health MarketScan Commercial Claims and Encounters Database, which does not account for cancer severity, quality-of-life-scores and death-related variables. This served as the main limitation to this study.
Researchers also could not determine whether the decline in enrollment between follow-ups was due to death or a change in health care plans.
Without the ability to perform a larger randomized clinical trial, the evidence presented by Stearns and colleagues “is as good as we may get” to show that targeted drug delivery is better care at a cheaper cost, Thomas J. Smith, MD, Harry J. Duffey Family professor of palliative medicine, professor of oncology and director of palliative medicine at Johns Hopkins University and Sidney Kimmel Comprehensive Cancer Center, and Bruce E. Hillner, MD, professor of medicine at Virginia Commonwealth University Massey Cancer Center, wrote in an accompanying editorial.
“The major strength [of this study] is the completeness of the cost accounting, including downstream costs,” Smith and Hillner wrote. “The major weakness is that with database studies, causality cannot be ascertained, only association. The patients receiving conventional medical management could have been sicker and thus the surgeons may have hesitated to perform implantation leading to these patients having more hospital days.
“We hope that patients with cancer, caregivers, oncologists, interventional pain specialists, and payers can work together to make this technology more accessible,” they added. – by John DeRosier
Disclosures: Medtronic funded this study. Stearns reports consultant roles with or research funding from Alfred Mann Foundation, Boston Scientific, Flowonix, Mallinckrodt Pharmaceuticals, Medallion Therapeutics Inc., Medtronic, Nevro, Piramal and Spinal Modulation. Please see the study for all other authors’ relevant financial disclosures. Smith reports grants from Medtronic outside of the submitted work and serving as principal investigator of a cancer pain trial comparing comprehensive medical management only with comprehensive medical management and targeted drug delivery for patients with cancer. Hillner reports no relevant financial disclosures.
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