Objective : To evaluate the benefits of adding patient-controlled intrathecal analgesia (PCIA) with an on-demand bolus device for breakthrough pain control on systemic opioid consumption and consequent cost-savings in patients previously implanted with intrathecal morphine pump (ITMP).
Design and subjects : Study is designed as retrospective cohort study at tertiary university hospital for chronic non-cancer pain patients who were previously implanted with ITMP by the end of 2016
Methods : We fitted linear mixed effects models to the longitudinal data for 2 years from December 2016. The primary outcomes were the adjusted effect size of PCIA on daily morphine milligram equivalent (MME/d) of all systemic opioids other than intrathecal dose and daily costs for systemic opioids. The secondary outcomes were personalized actual net cost-savings.
Results : Thirty-one patients were analyzed. PCIA was prescribed to 23 patients, and 6 withdrew during the observation period. PCIA was estimated to be associated with -24.0 MME/d (95% CI, -34.8 to -13.0; P < 0.001) of systemic opioid consumption change and -2.4 USD/d (95% CI, -3.9 to -0.8; P < 0.001) of cost change for systemic opioids. Including time-dependent cost change, initial device charge, and extra refill cost, the maintaining PCIA resulted in 128 USD (IQR, -134 to 513) of actual net cost change for 2 years in the study population, which could be maximally optimized to -230 USD (IQR, -335 to -78).
Conclusion : Our model suggests that add-on PCIA to previously implanted ITMP is associated with significant reduction of additional systemic opioid consumption and consequent cost-savings.