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Assessment of Health Care Costs and Total Baclofen Use Associated With Targeted Drug Delivery for Spasticity.

Publication ,  Journal Article
Venkatraman, V; Spears, CA; Futch, BG; Yang, LZ; Parente, BA; Lee, H-J; Lad, SP
Published in: Neuromodulation
August 2023

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.

Duke Scholars

Published In

Neuromodulation

DOI

EISSN

1525-1403

Publication Date

August 2023

Volume

26

Issue

6

Start / End Page

1247 / 1255

Location

United States

Related Subject Headings

  • Neurology & Neurosurgery
  • Muscle Spasticity
  • Muscle Relaxants, Central
  • Injections, Spinal
  • Humans
  • Health Care Costs
  • Baclofen
  • Adult
  • 3209 Neurosciences
  • 3202 Clinical sciences
 

Citation

APA
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ICMJE
MLA
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Venkatraman, V., Spears, C. A., Futch, B. G., Yang, L. Z., Parente, B. A., Lee, H.-J., & Lad, S. P. (2023). Assessment of Health Care Costs and Total Baclofen Use Associated With Targeted Drug Delivery for Spasticity. Neuromodulation, 26(6), 1247–1255. https://doi.org/10.1016/j.neurom.2023.01.017
Venkatraman, Vishal, Charis A. Spears, Brittany G. Futch, Lexie Z. Yang, Beth A. Parente, Hui-Jie Lee, and Shivanand P. Lad. “Assessment of Health Care Costs and Total Baclofen Use Associated With Targeted Drug Delivery for Spasticity.Neuromodulation 26, no. 6 (August 2023): 1247–55. https://doi.org/10.1016/j.neurom.2023.01.017.
Venkatraman V, Spears CA, Futch BG, Yang LZ, Parente BA, Lee H-J, et al. Assessment of Health Care Costs and Total Baclofen Use Associated With Targeted Drug Delivery for Spasticity. Neuromodulation. 2023 Aug;26(6):1247–55.
Venkatraman, Vishal, et al. “Assessment of Health Care Costs and Total Baclofen Use Associated With Targeted Drug Delivery for Spasticity.Neuromodulation, vol. 26, no. 6, Aug. 2023, pp. 1247–55. Pubmed, doi:10.1016/j.neurom.2023.01.017.
Venkatraman V, Spears CA, Futch BG, Yang LZ, Parente BA, Lee H-J, Lad SP. Assessment of Health Care Costs and Total Baclofen Use Associated With Targeted Drug Delivery for Spasticity. Neuromodulation. 2023 Aug;26(6):1247–1255.
Journal cover image

Published In

Neuromodulation

DOI

EISSN

1525-1403

Publication Date

August 2023

Volume

26

Issue

6

Start / End Page

1247 / 1255

Location

United States

Related Subject Headings

  • Neurology & Neurosurgery
  • Muscle Spasticity
  • Muscle Relaxants, Central
  • Injections, Spinal
  • Humans
  • Health Care Costs
  • Baclofen
  • Adult
  • 3209 Neurosciences
  • 3202 Clinical sciences