itb-costs

Cost-Effectiveness

Cost Element	Cost (1992 Dollars)	Expected Frequency
Implantation: Infusion System (pump) Surgery & Hospitalization and associated costs	$7,000 $15,700	Once
Refills: Physician Services / Visits Lioresal Intrathecal Drug	$220 $405	Nine per year (on average)
Pump Replacement: Infusion System (pump) Surgery & Hospitalization and associated costs	$7,000 $9,500	Every 4 - 5 years
Complications: (e.g. catheter kinking)	$3,400	10 - 20 % of patients

Savings Components of ITB Therapy

Medical Components	Economic Components
Pain Contractures Skin breakdown Bladder and bowel dysfunction Impaired ambulation ability Impaired sleep patterns Impaired respiratory function Hypertension	Hospitalization costs Physician fees Attendant care costs Other anti-spasticity medication Disability income costs

Annual Associated Costs of Care	Without Lioresal Intrathecal Therapy	With Lioresal Intrathecal Therapy	Estimated % Savings
Hospitalization Costs	$12,100	$7,800	+36%
Physician Fees	$1,400	$1,400	0%
Paid Attendant Care Costs	$10,100	$3,300	+67%
Unpaid Attendant Care Costs	$9,500	$6,100	+36%
Other Antispasticity Medications	$3,000	0	+100%
Other Costs of Care	$3,200	$4,000	-25%
Disability Income Costs	$16,400	$11,200	+32%
Total Associated Costs of Care	$55,700	$33,800	+39%

(Dollar estimates are 1992 values. Other cost of care include nursing home costs, rehabilitation and occupational therapy costs and other miscellaneous costs.

NET ANNUAL ECONOMIC BENEFITS OF LIORESAL INTRATHECAL THERAPY

1992 Dollars	Years 1 - 4	Years 5+
Reductions in Associated Costs of Care	$21,900	$21,900
Direct Costs of Lioresal Intrathecal Therapy
Implantation	$6,850	0
Pump Replacement	0	$4,130
Complications	$340	$340
Physicians Fees for Refill	$1,980	$1,980
Lioresal Intrathecal Drug	$3,650	$3,650
Total Therapy Costs	$12,820	$10,100
Net Annual Economic Benefits	$9,080	$11,800

(Inital implantation costs amortized over four years @ 8%.)

Cost-Effectiveness References

1992--Charles River Associates Economic Model

1995--Nance, Patricia; Can. J. Neurol. Sci.:22:22 - 29; Intrathecal Baclofen Therapy for Adults with Spinal Spasticity: Therapeutic Efficacy and Effect on Hospital Admissions

1996--Ordia, Joe; J. Neurosurg:452-457; Chronic Intrathecal Delivery of Baclofen by a Programmable Pump for the Treatment of Severe Spasticity

1995--Becker, WJ; Can. J. Neurol. Sci.:22: 208 - 217; Long Term Intrathecal Baclofen Therapy in Patients with Intractable Spasticity

Comparison of Cost Findings

Charles River Associates	Savings of > $9,000 per year
Nance Study	Reduced hospital admission over 2 years = Savings > Canadian $25,000 / patient (average: Canadian $12,500 per year)
Ordia Study	Reduced hospital days over 2 years = Savings of $6,750 / patient per year
Becker Study	Reduced hospital days over 1 year = Savings of Canadian $31,300 per patient

ITB Economic Model

Estimate of cost savings based on 3 parameters:

severe spasticity
decubitus ulcers
urinary complications

Does not include surgical / hospitalization cots associated with fractures, contractures, heterotopic ossification

Net Annual Savings:

Years 1-4 = $9,100
Years 5 and beyond = $11,800

Estimated 39% savings in total costs of care

Cost Data from: Nance et al.

Method	Results
Prospective Canadian clinical study 7 Spinal Cord Injury and Multiple Sclerosis patients; 6 for cost data Clinical follow-up of 24 - 41 months Cost savings assessed by comparing the number of inpatient hospital days 2 years before and 2 years after ITB implant Used cost / day of Canadian $813	Total spasticity-related hospital days for all 6 patients during the 2 year pre-implant period = 376 (translates to Canadian $305,688) Only 136 days for 2 years post-implant (all ITB-related). No spasticity-related hospital days Net savings = Canadian $153,120 for the 6 patients

Cost Data from: Ordia et al.

Method	Results
Prospective US clinical study Cost data on 10 out of 59 severe Spinal Origin Spasticity patients Average clinical follow-up = 42 months Compared number of hospitalizations and Altered Length of Stay for 1 year before and after ITB implant	Altered Length of Stay / patient decreased by 2.7 days Change in ALOS resulted in “savings” of $6,750 / patient Authors also calculated payback period of pump-- cost of pump implant paid back in less than 2.5 years on average

Cost Data from: W.J. Becker

Method	Results
Prospective Canadian clinical study 9 non-ambulatory Spinal Origin Spasticity patients Average clinical follow-up of 27 months Cost assessed by comparing total number of hospital days (all 9 patients) for 1 year before and after ITB implant	Authors calculated savings of Canadian $23,970 / patient Savings from decrease in total hospital days Other “outcomes” include improved transfers, improved pain control, improved skin condition, and improved ease of care

Other Cost Implications

R. Becker, “Continuous Intrathecal Baclofen Infusion in Severe Spasticity after Traumatic or Hypoxic Brain Injury”, J. of Neurology, 1997; 244.

Prospective German study done on 18 Cerebral Origin Spasticity patients
Noted daily savings of Deutsche Mark1.26 to Deutsche Mark 3.26 from decrease in oral anti-spasticity medications
Suggest that ITB be given sooner to prevent limb contractures

Meythaler, “Prospective Assessment of Continuous Infusion of Baclofen for Spasticity Caused by Acquired Brain Injury...”, J. of Neurosurgery, 1997: 87.

Prospective U.S. study of 12 patients with Cerebral Origin Spasticity
Outcomes include a significant decrease in joint contractures (7 patients)

Gerszten et al., “Intrathecal baclofen infusion and subsequent orthopedic surgery in patients with spastic cerebral palsy”, J. of Neurosurgery, 1998; 88.

Retrospective study of 48 CP patients who received ITB Therapy
At time of implant, subsequent orthopedic surgery planned in 28 patients
After ITB Therapy 18 patients (64%) no longer needed orthopedic surgery
“Lower-extremity spasticity had improved to the degree that intervention was no longer indicated”

Dollar values calculated for 1992-4

INformation obtained with the assistance of medtronic, inc.