Abstract
Background
Chronic spasticity causes significant impairment and financial burden. Oral baclofen,
the first-line therapy, can have intolerable, dose-dependent side effects. Targeted
drug delivery (TDD) through intrathecal baclofen delivers smaller amounts of baclofen
into the thecal sac via an implanted infusion system. However, the health care resource
utilization of patients with spasticity receiving TDD has not been studied extensively.
Materials and Methods
Adult patients who received TDD for spasticity between 2009 and 2017 were identified
using the IBM MarketScan® data bases. Patients’ use of oral baclofen and health care
costs were examined at baseline (one year before implantation) and three years after
implantation. A multivariable regression model using the generalized estimating equations
method and a log link function was used to compare postimplantation costs with those
at baseline.
Results
The study identified 771 patients with TDD for medication analysis and 576 for cost
analysis. At baseline, the median costs were $39,326 (interquartile range [IQR]: $19,526–$80,679),
which increased to $75,728 (IQR: $44,199–$122,676) in year 1, decreased to $27,160
(IQR: $11,896–$62,427) in year 2, and increased slightly to $28,008 (IQR: $11,771–$61,885)
in year 3. In multivariable analysis, the cost was 47% higher than at baseline (cost
ratio [CR] 1.47, 95% CI: 1.32–1.63) in year 1 but was 25% lower (CR 0.75, 95% CI:
0.66–0.86) in year 2 and 32% lower (CR 0.68, 95% CI: 0.59–0.79) in year 3. Before
implant, 58% of patients took oral baclofen, which decreased to 24% by year 3. The
median daily baclofen dose decreased from 61.8 mg (IQR: 40–86.4) before TDD to 32.8
mg (IQR: 30–65.7) three years later.
Conclusions
Our findings indicate that patients who undergo TDD use less oral baclofen, potentially
reducing the risk of side effects. Although total health care costs increased immediately
after TDD, most likely owing to device and implantation costs, they decreased below
baseline after one year. The costs of TDD reach cost neutrality approximately three
years after implant, indicating its potential for long-term cost savings.
Keywords
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Comments
Article info
Publication history
Published online: March 06, 2023
Accepted:
January 23,
2023
Received in revised form:
January 17,
2023
Received:
November 21,
2022
Publication stage
In Press Corrected ProofFootnotes
Source(s) of financial support: This publication was made possible (in part) by Grant Number UL1TR002553 from the National Center for Advancing Translational Sciences (NCATS) of the National Institutes of Health (NIH), and NIH Roadmap for Medical Research. Its contents are solely the responsibility of the authors and do not necessarily represent the official views of NCATS or NIH.
Conflict of Interest: The authors reported no conflict of interest.
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© 2023 International Neuromodulation Society. Published by Elsevier Inc. All rights reserved.
