Sacral neuromodulation cost-effective for fecal incontinence

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Sacral neuromodulation (SNM) is less costly than dynamic graciloplasty (DGP) and artificial bowel sphincter (ABS) for the treatment of fecal incontinence, show the results of a Dutch health economics study.

"The present study has shown that a treatment strategy including SNM is cost saving for each successfully treated patient. When compared with treatment combinations not including SNM, the use of SNM generates the same number of QALYs [quality-adjusted life years] at a lower price," say Bart van Wunnik (Maastricht University Medical Center, the Netherlands) and colleagues.

The authors generated a Markov model based on two strategies: SNM- including the use of an artificial sphincter (DGP 50%/ABS 50%) and SNM+ (SNM 80%/DGP 10%/ABS 10%).They ran a hypothetical cohort of patients through the model for five 1-year cycles to generate outcomes, using quality of life data from patients treated at their center over a 10-year period and costs based on the hospital's prospective patient database to generate QALYs.

The authors found that the SNM- strategy cost € 22,651 (US$ 28,490) per patient compared with € 16,473 (US$ 20,720) per patient with the SNM+ strategy. This was due to ABS being more costly than both SNM and DGP, and the fact that patients in the SNM+ strategy required fewer revisions than patients in the SNM- strategy (6 vs 31%).

The SNM+ also resulted in a higher success rate at 5 years than the SNM- strategy (82 vs 59%), which meant that the cost per successfully treated patient was also lower (€ 20,113 [US$ 25,298] vs € 38,392 [US$ 48290]).

The QALYs gained were similar for SNM+ and SNM-, at 4.21 and 4.14 cumulative over 5 years per patient, respectively. However, because the SNM+ strategy was cheaper, the cost per QALY was lower at € 3912 (US$ 4920) compared with € 5471 (US$ 6881) in the SNM- strategy.

The authors say that their findings provide valuable information about SNM, which offers a less-invasive alternative to the traditional techniques of DGP and ABS: "There is… only limited evidence of the cost-effectiveness of SNM and at present the Dutch healthcare system does not fully reimburse the cost of SNM," they write in Colorectal Disease.

They say that their findings support the funding of SNM as a cost-effective technique. However, they add that further studies are needed: "Prospective studies comparing the effectiveness and complications of SNM- and SNM+ in the long-term, and their effect on the quality of life are required to confirm the cost-effectiveness and the robustness of our results."

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