Long-term cost-effectiveness analysis of sacral neuromodulation in the treatment of severe faecal incontinence.

Autor: de Miguel Valencia MJ; General Surgery Service, Hospital Reina Sofía de Tudela, Tudela, Spain., Cabasés Hita JM; Department of Economics, Public University of Navarre (UPNA), Pamplona, Spain., Sánchez Iriso E; Department of Economics, Public University of Navarre (UPNA), Pamplona, Spain., Oteiza Martínez F; Colorectal Surgery Unit, Hospital Universitario de Navarra, Pamplona, Spain., Alberdi Ibañez I; General Surgery Service, Hospital Reina Sofía de Tudela, Tudela, Spain., Álvarez López A; General Surgery Service, Hospital Reina Sofía de Tudela, Tudela, Spain., Ortiz Hurtado H; Colorectal Surgery Unit, Hospital Universitario de Navarra, Pamplona, Spain., de Miguel Velasco MJ; Colorectal Surgery Unit, Hospital Universitario de Navarra, Pamplona, Spain.
Jazyk: angličtina
Zdroj: Colorectal disease : the official journal of the Association of Coloproctology of Great Britain and Ireland [Colorectal Dis] 2023 Sep; Vol. 25 (9), pp. 1821-1831. Date of Electronic Publication: 2023 Aug 07.
DOI: 10.1111/codi.16692
Abstrakt: Aim: The aim of this study was to evaluate the long-term cost-effectiveness of sacral neuromodulation in the treatment of severe faecal incontinence as compared with symptomatic management.
Methods: In the public health field, a micro-costing evaluation method was conducted from the perspectives of the health system and the society. The incremental cost-effectiveness ratio was used as a decision index, and we considered various scenarios to evaluate the impact of the cost of symptomatic management and percutaneous nerve evaluation success rate in its calculation. Clinical data were retrieved from a consecutive cohort of 93 patients with severe faecal incontinence undergoing sacral neuromodulation after a failure of conservative (pharmacological and biofeedback) and/or surgical (sphincteroplasty) first-line treatments were considered.
Results: The long-term incremental cost-effectiveness ratio comparing sacral neuromodulation versus symptomatic management was 14347€/QALY and 28523€/QALY from the societal and health service provider's perspectives, respectively. If the definitive pulse generator implant success rate was 100%, incremental cost-effectiveness would correspond to 6831€/QALY and 16761€/QALY, respectively.
Conclusions: Sacral neuromodulation may be considered a cost-effective technique in the long-term treatment of severe faecal incontinence from the societal and health care sector perspectives. Improving patient selection and determining the predictive outcome factors for successful sacral neuromodulation in the treatment of faecal incontinence would improve cost-effectiveness.
(© 2023 Association of Coloproctology of Great Britain and Ireland.)
Databáze: MEDLINE
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