Intrathecal drug delivery systems: an overview of cost-effectiveness evidence

Economic evaluations, which systematically compare the costs and health-related outcomes of health interventions, are essential for informing resource allocation decisions, particularly in the context of financial constraints and limited healthcare budgets. Intrathecal drug delivery (ITDD) systems are widely used for the management of cancer pain, chronic non-cancer pain, and spasticity. However, ITDD involves substantial upfront costs, ongoing maintenance expenses, and potential complications. This article provides an overview of health-related economic evaluation principles and of the evidence on the cost-effectiveness of ITDD systems across cancer pain, chronic non-cancer pain, and spasticity. Published studies include both full and partial economic evaluations, conducted from varying perspectives and in diverse healthcare settings. Most analyses suggest that ITDD is cost-effective compared with conventional management strategies, particularly for cancer-related pain and spasticity. However, the robustness of these findings is limited by methodological heterogeneity and reliance on effectiveness data that are often derived from small or uncontrolled studies. Evidence for chronic non-cancer pain is especially sparse and inconsistent, highlighting the need for further research using rigorous designs and comprehensive cost data. Given the high costs and complexity of ITDD systems, strengthening the evidence base on their clinical and economic value is critical to support informed decision-making by health technology assessment bodies and payers. Future studies should prioritize comparative effectiveness research and long-term economic modeling to address current gaps and uncertainties.