Intrathecal drug delivery versus comprehensive medical management as it may impact inpatient length of stay, readmission, and inpatient cost of care

Abstract

18520 Background: Long lengths of stay (LOS) and high readmission rates partly explain the high medical costs of treating cancer patients. Uncontrolled pain is the number two reason for hospital readmission. Aggressive measures and treatment strategies for relieving intractable cancer pain can require the implantation and management of intrathecal (IT) drug delivery systems. The objective was to examine LOS, episodes of readmission, intensive care (ICU) stays, and discharge status among patients treated with IT versus comprehensive medical management (CMM) for pain. Methods: Retrospective case-control medical record review methods were employed. Sixty-three randomly selected cancer patients who received an IT were matched on gender, age group, and primary diagnosis to 63 who did not. Results: The total LOS for the 63 non-IT patients was 567 days. The total LOS for the 63 IT patients was 301 days. The mean LOS among the non-IT patients was 9 days. The mean LOS among the IT patients was 4.7 days. Total LOS for the non-IT patients was statistically significantly higher. Among the 63 non-IT patients 94 total inpatient episodes were experienced. Among the 63 IT patients 68 total inpatient episodes were experienced. The likelihood of a non-IT patient readmitting was nine-fold higher than the IT patients and statistically significantly different. The total Intensive Care Unit (ICU) days for the 63 non-IT patients were 60 days. The total ICU days for the 63 IT patients were 30 days. The total ICU for the non-IT patients was not statistically significantly higher. The likelihood of a non-IT patient expiring while an inpatient was fourteen-fold higher than the IT patients and was statistically significantly different. The average cost per episode was 22% higher among the IT group versus the non-IT group. Conclusions: The implantable IT system for pain management among cancer patients experiencing intractable pain may be a significant influence on patient LOS, readmission, and ICU episodes even though it represents a 22% increase in average inpatient costs per episode. Controlled studies examining these hospital indicators as primary outcomes for these patients by evaluating the IT drug delivery system as compared to CMM are warranted. No significant financial relationships to disclose.