Comparative Cost-Effectiveness Analysis of Sacral Anterior Root Stimulation for Rehabilitation of Bladder Dysfunction in Spinal Cord Injured Patients

Abstract

The effectiveness and cost of SARS are much higher than for medical treatment. Our results inform decision makers of the opportunity to reimburse SARS in this vulnerable population.

Electrical nerve stimulation to promote micturition in spinal cord injury patients: A review of current attempts

“…With respect to long term effectiveness and ease of use across a patient's life time, complete and voluntary micturition by the Brindley procedure is much improved compared to conventional neurogenic bladder treatment . After implantation, the advantages of the Brindley procedure were reported as: reduction of infection rate (68%), improved social life (54%) and continence (54%), which were coincident with patients' expectations, and accompanied with improved QoL .…”

“…The reason may be the unfamiliarity with this procedure by the patients and their doctors; fear of major spinal surgery, the pre‐requisition for and permanence of posterior root rhizotomy, and doubts about the effects of surgery. The cost of the Brindley device (42,803 euro in the first 12 months after implantation) is a huge burden on healthcare providers and insurers, and prohibitive to patients in the poorer regions of the world.…”

Chronic infection of a Brindley sacral nerve root stimulator

“…Reasons for its limited use may include relative physician unfamiliarity with the technique,7 significantly higher costs compared with current medical treatments,20 and significant neurological complications including DSD. Methods to minimise such complications include the design of a closed loop neuroprosthetic interface, which can coordinate sensory reception of bladder fullness at the posterior roots with bladder emptying via stimulation of the ventral roots 21.…”

Economics, Innovation, and Quality Improvement in Neurosurgery

“…In an assessment of the neurosurgical innovation, the investigators expressed the results of their ICER calculations as the cost per additional patient with complete and voluntary micturition. 9 This type of costeffectiveness analysis is valuable; however, it is restricted by the inability to calculate differences in multidimensional outcomes and a paucity of standard benchmarks for what individuals are willing to pay. Because there is not a standard value for what society or an individual would be willing to pay for the specific outcome of having an additional spinal cord-injured patient achieve complete and voluntary micturition, it is difficult to say if sacral anterior root stimulation should be included in general practice based on the findings of this study.…”