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21KF-058
Comparison on healthcare utilization patterns by pain treatment method: A nation-wide claims database analysis
Hyung Sang Row1, Yongjae Yoo1, Haine Lee2, Huynsook Choi2, Jee Youn Moon1 
Department of Anesthesiology and Pain Medicine, Seoul National University Hospital, Seoul, Republic of Korea1
Healthcare Economics and Government Affairs, Medtronic Korea Ltd., Seoul, Republic of Korea2
Background
Intrathecal (IT) opioid therapy is a treatment alternative for patients with chronic non-cancer pain. Several outcome studies have suggested a benefit of intrathecal morphine pump (ITMP) in chronic non-cancer pain patients, but there was no study about the changes in opioid use after ITMP implantation. This study aimed to investigate the changes in opioid use and medical care utilization behavior and compare the pharmacological treatment group and the ITMP group

Methods
Our study assessed the healthcare utilization patterns by pain treatment method between ITMP group and conventional medical management (CMM) group using the Korean National Health Insurance Service Sample Cohort from 2013 to 2018. The study population consisted of patients who were diagnosed with fibromyalgia, complex regional pain syndrome type 1 and 2, post laminectomy syndrome and prescribed opioids. Primary outcome was daily oral Morphine Milligram Equivalent (MME) for six and twelve months after pump implantation. Number of emergency room visit, number/days of hospitalization, total medical expenditure were analyzed as secondary outcomes.

Results
82 patients (N = 24 in ITMP group and N = 59 in CMM group) were analyzed. The average MME in 6 months and 12 months in ITMP group was lower than in CMM group [32.71 versus 44.92, P = 0.04, and 27.11 versus 42.90, P = 0.01, respectively]. The number of emergency room visit during 6 months and 12 months was higher in IDDS group than in CMM group [46.63 versus 39.50, P < 0.01, and 48.16 versus 36.00, P < 0.01, respectively] but hospitalization and total medical expenditure showed no significant differences.

Conclusions
ITMP provided effective chronic non-cancer pain management with lower opioid consumption than conventional medical treatment.

References
1. Kim EK, Shin JY, Castae SJ, Yoon HK, Kim YC, Moon JY. Retrospective analysis of the financial break-even point for intrathecal morphine pump use in Korea. Korean J Pain. 2017 Oct;30(4):272-280.
2. Duarte RV, Raphael JH, Haque MS, Southall JL, Ashford RL. A predictive model for intrathecal opioid dose escalation for chronic non-cancer pain. Pain Physician. 2012 Sep-Oct;15(5):363-9.