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Intrathecal Baclofen Therapy in Patients With Multiple Sclerosis: Improved Outcomes and Reduced Costs Through Identification of Catheter Malfunction.
Neuromodulation. 2019 Oct; 22(7):839-842.N

Abstract

INTRODUCTION

Two patients previously implanted with intrathecal Baclofen (ITB) pumps for management of intractable spasticity due to multiple sclerosis (MS) were referred to our center for ongoing management of their spasticity. Initial evaluation of these patients revealed high levels of spasticity in the presence of ITB doses 10 times the average daily dose of our other MS patients.

CLINICAL FACTS

High doses of ITB required frequent clinical visits and result in high drug and procedure costs. Both patients' daily doses were greater than 1000 mcg/day resulting in clinical visits every 1-2 months with drug and procedure costs ranging from 16 to 23 thousand dollars annually based on Medicare national average pricing for physician's office. Of the 59 MS patients receiving ITB therapy at our institution, the mean, median, and mode daily doses for ITB are 184, 115, and 159 mcg/day, respectively. The high ITB doses in these patients and poor spasticity control raised suspicion for pump/catheter malfunction and prompted immediate troubleshooting.

FINDINGS

One patient's catheter was found to be disconnected from the pump and the other's catheter tip was outside the intrathecal space. In both cases, the patients were not receiving the therapy. After pump/catheter replacement, both patients received excellent clinical benefits from ITB at significantly lower daily doses. This reduction in dose resulted in decreased frequency of medication refills (twice annually) which resulted in decreased cost of care (12-19 thousand dollars savings annually per patient).

DISCUSSION

These cases illustrate the need for early ITB pump troubleshooting to identify catheter problems, improve efficacy, and avoid unnecessary healthcare costs.

Authors+Show Affiliations

Department of Physical Medicine and Rehabilitation, Medical College of Wisconsin, Milwaukee, WI, USA.Department of Physical Medicine and Rehabilitation, Medical College of Wisconsin, Milwaukee, WI, USA.

Pub Type(s)

Case Reports

Language

eng

PubMed ID

31157471

Citation

Nelson, Mary Elizabeth S., and John R. McGuire. "Intrathecal Baclofen Therapy in Patients With Multiple Sclerosis: Improved Outcomes and Reduced Costs Through Identification of Catheter Malfunction." Neuromodulation : Journal of the International Neuromodulation Society, vol. 22, no. 7, 2019, pp. 839-842.
Nelson MES, McGuire JR. Intrathecal Baclofen Therapy in Patients With Multiple Sclerosis: Improved Outcomes and Reduced Costs Through Identification of Catheter Malfunction. Neuromodulation. 2019;22(7):839-842.
Nelson, M. E. S., & McGuire, J. R. (2019). Intrathecal Baclofen Therapy in Patients With Multiple Sclerosis: Improved Outcomes and Reduced Costs Through Identification of Catheter Malfunction. Neuromodulation : Journal of the International Neuromodulation Society, 22(7), 839-842. https://doi.org/10.1111/ner.12974
Nelson MES, McGuire JR. Intrathecal Baclofen Therapy in Patients With Multiple Sclerosis: Improved Outcomes and Reduced Costs Through Identification of Catheter Malfunction. Neuromodulation. 2019;22(7):839-842. PubMed PMID: 31157471.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Intrathecal Baclofen Therapy in Patients With Multiple Sclerosis: Improved Outcomes and Reduced Costs Through Identification of Catheter Malfunction. AU - Nelson,Mary Elizabeth S, AU - McGuire,John R, Y1 - 2019/06/03/ PY - 2018/12/06/received PY - 2019/03/21/revised PY - 2019/04/25/accepted PY - 2019/6/4/pubmed PY - 2020/3/21/medline PY - 2019/6/4/entrez KW - Baclofen KW - case report KW - complications KW - cost-benefit analysis KW - intrathecal catheter KW - intrathecal therapy KW - multiple sclerosis KW - spasticity SP - 839 EP - 842 JF - Neuromodulation : journal of the International Neuromodulation Society JO - Neuromodulation VL - 22 IS - 7 N2 - INTRODUCTION: Two patients previously implanted with intrathecal Baclofen (ITB) pumps for management of intractable spasticity due to multiple sclerosis (MS) were referred to our center for ongoing management of their spasticity. Initial evaluation of these patients revealed high levels of spasticity in the presence of ITB doses 10 times the average daily dose of our other MS patients. CLINICAL FACTS: High doses of ITB required frequent clinical visits and result in high drug and procedure costs. Both patients' daily doses were greater than 1000 mcg/day resulting in clinical visits every 1-2 months with drug and procedure costs ranging from 16 to 23 thousand dollars annually based on Medicare national average pricing for physician's office. Of the 59 MS patients receiving ITB therapy at our institution, the mean, median, and mode daily doses for ITB are 184, 115, and 159 mcg/day, respectively. The high ITB doses in these patients and poor spasticity control raised suspicion for pump/catheter malfunction and prompted immediate troubleshooting. FINDINGS: One patient's catheter was found to be disconnected from the pump and the other's catheter tip was outside the intrathecal space. In both cases, the patients were not receiving the therapy. After pump/catheter replacement, both patients received excellent clinical benefits from ITB at significantly lower daily doses. This reduction in dose resulted in decreased frequency of medication refills (twice annually) which resulted in decreased cost of care (12-19 thousand dollars savings annually per patient). DISCUSSION: These cases illustrate the need for early ITB pump troubleshooting to identify catheter problems, improve efficacy, and avoid unnecessary healthcare costs. SN - 1525-1403 UR - https://www.unboundmedicine.com/medline/citation/31157471/Intrathecal_Baclofen_Therapy_in_Patients_With_Multiple_Sclerosis:_Improved_Outcomes_and_Reduced_Costs_Through_Identification_of_Catheter_Malfunction_ L2 - https://doi.org/10.1111/ner.12974 DB - PRIME DP - Unbound Medicine ER -