Retrospective analysis of the financial break-even point for intrathecal morphine pump use in Korea

Abstract

Background: The high cost of intrathecal morphine pump (ITMP) implantation may be the main obstacle to its use. Since July 2014, the Korean national health insurance (NHI) program began paying 50% of the ITMP implantation cost in select refractory chronic pain patients. The aims of this study were to investigate the financial break-even point and patients' satisfaction in patients with ITMP treatment after the initiation of the NHI reimbursement.

Methods: We collected data retrospectively or via direct phone calls to patients who underwent ITMP implantation at a single university-based tertiary hospital between July 2014 and May 2016. Pain severity, changes in the morphine equivalent daily dosage (MEDD), any adverse events, and patients' satisfaction were determined. We calculated the financial break-even point of ITMP implantation via investigating the patient's actual medical costs and insurance information.

Results: During the studied period, 23 patients received ITMP implantation, and 20 patients were included in our study. Scores on an 11-point numeric rating scale (NRS) for pain were significantly reduced compared to the baseline value (P < 0.001). The MEDD before ITMP implantation was 0.59 [IQR: 0.55-0.82]. The total MEDD increased steadily to 0.77 [IQR: 0.53-1.08] at 1 year, which was 126% of the baseline (P < 0.001). More than a half (60%) responded that the ITMP therapy was somewhat satisfying. The financial break-even point was 28 months for ITMP treatment after the NHI reimbursement policy.

Conclusions: ITMP provided effective chronic pain management with improved satisfaction and reasonable financial break-even point of 28 months with 50% financial coverage by NHI program.

Keywords: Chronic pain; Cost; Drug dosage calculation; Health insurance; Intrathecal morphine pump; Morphine; Patient satisfaction.

Fig. 1. Flowchart. NHI: national health insurance, MA: medical aid, WCP: worker's compensation plans, CI: car insurance, FBEP: financial break-even point. ^*Thirteen patients that received 50% benefits from the new NHI policy were included to calculate the financial break-even point.

Fig. 2. NRS pain scores from pre-implantation to 12 months after transplantation. The box plot shows a set of three quartiles and the maximum and minimum graphically. At Pre-ITMP and 3 months, the maxima are not displayed because they were same as the median 3rd quartile and the 3rd quartile, respectively. NRS: numerical rating scale, ITMP: intrathecal morphine pump. ^*Statistically significant difference between the time point and Pre-ITPM (P < 0.05).

Fig. 3. Daily intrathecal morphine equivalent drug doses at various time points. “Total” indicates the total dose of morphine equivalent drug each patient took daily every 3 months. “IT” indicates the amount of morphine administered per day via ITMP. Pre-ITMP, opioid dose calculated as the equivalent intrathecal morphine dose before ITMP implantation. Post-ITMP, opioid dose calculated as the equivalent intrathecal morphine dose after ITMP implantation. We investigated every 3 months for 1 year from the start of treatment. IT: intrathecal, ITMP: intrathecal morphine pump, MEDD: morphine equivalent daily dose. ^*Statistically significant difference between the initial IT morphine dose and each time point (P < 0.001). ^**Statistically significant difference between the total IT morphine dose as the initial setting and each time point (P < 0.001).