- Department of Neurosurgery, University of Louisville, 220 Abraham Flexner Way, Suite 1500, Louisville, Kentucky, United States.
DOI:10.25259/SNI_15_2020Copyright: © 2020 Surgical Neurology International This is an open-access article distributed under the terms of the Creative Commons Attribution-Non Commercial-Share Alike 4.0 License, which allows others to remix, tweak, and build upon the work non-commercially, as long as the author is credited and the new creations are licensed under the identical terms.
How to cite this article: Zaid Aljuboori, William Burke, Kimberly Meyer, Brian Williams. Cost analysis of cordotomy and intrathecal pain pump placement for refractory cancer pain. 18-Apr-2020;11:72
How to cite this URL: Zaid Aljuboori, William Burke, Kimberly Meyer, Brian Williams. Cost analysis of cordotomy and intrathecal pain pump placement for refractory cancer pain. 18-Apr-2020;11:72. Available from: https://surgicalneurologyint.com/surgicalint-articles/9965/
Background: Cancer pain can be debilitating and 10–20% of patients will have refractory pain despite optimal medical management. Here, we present a cost comparison of treating terminal cancer patients with intravenous (IV) narcotics, anterolateral cordotomy, or intrathecal pain pump (ITPP) placement.
Case Description: We evaluated and treated 2 patients with metastatic breast cancer and expected survivals of
Conclusion: The treatment of refractory pain in cancer patients is challenging. It requires invasive procedures such as cordotomy or ITPP. Although procedures may yield comparable pain control, there was a significant cost savings for cordotomy versus ITPP ($57,043 saved).
Keywords: Cancer, Cost, Neuroablation, Neuromodulation, Opioids, Pain
Cancer-related pain represents a challenge to manage medically, and most patients will require higher and higher doses of opioid analgesics due to receptor downregulation, which puts them at risk of opioid addiction and death.[
A 53-year-old female with metastatic breast cancer presented with severe pain involving the right chest wall; her n expected survival was <1 year. She had failed oral narcotics and was admitted for 7 days of Dilaudid patient-controlled analgesia (PCA); nevertheless, this left her with a 5/10 residual pain score. She, therefore, underwent a left-sided C1-2 cordotomy which resulted in immediate pain relief. The PCA was weaned over 2 days and she was discharged home in stable condition. The total cost of her care was $108,346; $18,462 for the cordotomy, $89,884 for the hospital stay [
A 60-year-old female with metastatic breast cancer and an expected survival of <1 year presented with severe cancer- related pain involving the left knee cap. She failed oral narcotics and local nerve blocks. She was admitted for Dilaudid PCA, but her residual pain was 7/10 on the VAS, so she underwent ITPP placement. Immediately postoperatively she experienced partial pain relief and the PCA was weaned over 7 days (e.g., to titrate the intrathecal opioids), at which point she was discharged home. The total cost of her care totaled $165,389; $80,603 for the ITPP placement procedure (including the implants) and $84,786 for the hospital stay [
In 1986, the World Health Organization stated the following “to provide relief from pain to the patient’s satisfaction, so that [they] may function effectively and eventually die free from pain” in regard to cancer-related pain.[
In a cancer patient with expected survivals of <1 year, cordotomy saved about $57,053 in total cost versus ITPP. Therefore, for patients with estimated survivals of under 1 year, cordotomy was the most cost-effective versus ITPP in which is a better option in cancer patients with survival estimated at >1 year.
There is an obvious need for cost effective and adequate treatment for cancer-related pain. This study documented the lesser costs but comparable efficacy of utilizing cordotomy to treat patients with estimated survivals of <1 year versus the recommendation to consider ITPP for those with >1 year to live.
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