Implantable Drug Delivery Pumps

Abstract

Implantable drug delivery pumps offer a route to sustained, programmable pharmacotherapy that oral and injectable regimens cannot match, yet their clinical penetration remains uneven across therapeutic domains. We evaluated 196 implantable pump programmes deployed or trialled across hospitals in Spain, Germany, and Austria between 2015 and 2024, covering five therapeutic categories: chronic pain management, spasticity treatment, chemotherapy infusion, diabetes insulin delivery, and antibiotic depot therapy. A composite Implantable Pump Performance Index (IPPI) was constructed from five sub-scores -- dosing precision, device longevity, complication rate, patient-reported outcome improvement, and refill interval -- with weights derived from regression against sustained clinical adoption. IPPI correlated with continued clinical use at r = +0.81 and discriminated adopted from discontinued programmes with an AUC of 0.872. Chronic pain pumps scored highest (mean IPPI 0.814), while antibiotic depot systems trailed at 0.592. Only 34.2 percent of programmes exceeded the 0.75 IPPI threshold. Dosing precision carried the largest regression weight (beta = +0.274), followed by complication rate (beta = +0.234). These findings suggest that next-generation implantable pumps should prioritise closed-loop dosing feedback and biocompatible reservoir materials to reduce complications and extend device lifespan.