보험 급여 적용 후 척수강 내 모르핀 펌프에 대한 후향적 분석: 경제적 효율성을 중심으로

Abstract

Introduction: The aims of this study were to investigate the financial break-even point (FBEP) and patients satisfaction in patients who received IntraThecal Morphine Pump (ITMP) implantation after the initiation of the Korean National Health Insurance (KNHI) reimbursement policy in Korea.

Method: We collected data through retrospective database analysis and direct phone calls to patients who underwent ITMP implantation at the Seoul National University Hospital (SNUH) Pain clinic between July 2014 and May 2016. Pain severity, changes in the Morphine Equivalent Daily Dosage (MEDD), any adverse events associated with ITMP implantation, and patients satisfaction were determined. In addition, we calculated the FBEP of ITMP in patients via investigating the patient's actual medical costs and insurance information.

Results: During the period, 23 patients received ITMP implantation at SNUH, and 20 patients were included in our study. An 11-point NRS pain scores were significantly reduced compared to the baseline value (P < 0.001). The median intrathecal MEDD before ITMP implantation was 0.59 [IQR: 0.55-0.82]. Throughout the follow-up period, the total MEDD increased steadily to 0.77 [IQR: 0.53-1.08] at 1 year which was 126% of baseline (P < 0.001). More than a half (60%) responded that the ITMP therapy was somewhat satisfying and 16 patients (80%) agreed that the ITMP helped to control their pain. The FBEP was 28 months for ITMP implantation treatment after the KNHI reimbursement policy. Conclusions: In conclusion, ITMP provided effective chronic pain management with improved satisfaction and reasonable FBEP of 28 months with 50% financial coverage by KNHI program.