Cost‐effectiveness analysis of sacral neuromodulation for faecal incontinence in the Netherlands

Wunnik, B.P.W. van; Visschers, Ruben G.J.; Asselt, Antoinette D. I. van; Baeten, C. G. M. I.

doi:10.1111/codi.12002

Cited by 18 publications

(15 citation statements)

References 22 publications

(28 reference statements)

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“…Health utilities for patients with faecal incontinence, derived using EQ-5D, were taken from published studies 11 , 18 , 21 ( Table 1 ). Due to a lack of published data on dis-utilities associated with adverse events for SNS, we used utilities for neuropathic pain derived using EQ-5D.…”

Section: Methodsmentioning

confidence: 99%

Cost-effectiveness of sacral nerve stimulation and percutaneous tibial nerve stimulation for faecal incontinence

Hounsome

Roukas

2018

Therap Adv Gastroenterol

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Background:Subcutaneous sacral nerve stimulation is recommended by the United Kingdom (UK) National Institute for Health and Care Excellence (NICE) as a second-line treatment for patients with faecal incontinence who failed conservative therapy. Sacral nerve stimulation is an invasive procedure associated with complications and reoperations. This study aimed to investigate whether delivering less invasive and less costly percutaneous tibial nerve stimulation prior to sacral nerve stimulation is cost-effective.Methods:A decision analytic model was developed to estimate the cost-effectiveness of percutaneous tibial nerve stimulation with subsequent subcutaneous sacral nerve stimulation versus subcutaneous sacral nerve stimulation alone. The model was populated with effectiveness data from systematic reviews and cost data from randomized studies comparing both procedures in a UK National Health Service (NHS) setting.Results:Offering percutaneous tibial nerve stimulation prior to sacral nerve stimulation (compared with delivering sacral nerve stimulation straight away) was both more effective and less costly in all modeled scenarios. The estimated savings from offering percutaneous tibial nerve stimulation first were £662–£5,697 per patient. The probability of this strategy being cost-effective was around 80% at £20,000–£30,000 per quality-adjusted life-year (QALY).Conclusion:Our analyses suggest that offering patients percutaneous tibial nerve stimulation prior to sacral nerve stimulation can be both cost-effective and cost-saving in the treatment of faecal incontinence.

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Section: Methodsmentioning

confidence: 99%

Cost-effectiveness of sacral nerve stimulation and percutaneous tibial nerve stimulation for faecal incontinence

Hounsome

Roukas

2018

Therap Adv Gastroenterol

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“…The literature suggests that SNS is cost-effective for severe refractory FI [141][142][143][144][145][146][147], but studies on costeffectiveness have not taken into account the long-term loss of efficacy and the need for ongoing concurrent therapy.…”

Section: Cost-effectivenessmentioning

confidence: 99%

Sacral nerve stimulation for faecal incontinence and constipation: a European consensus statement

et al. 2015

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“…However, the high price of SNM remains an obstacle to apply this treatment method widely. Even though there are studies, showing that a treatment strategy, including SNM, is cost saving for each successfully treated patient [22], there is a growing interest in the potentially newer, less invasive and cheaper neuromodulation techniques, such as PTNM and Transcutaneous tibial nerve stimulation (TTNS), in the treatment of FI. For these reasons, we started PTNM in our clinic three years ago and we have treated a small amount of patients.…”

Section: Discussionmentioning

confidence: 99%

Sacral Neuromodulation for the Treatment of Faecal Incontinence: First Steps in Lithuania

et al. 2015

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SummaryTwo female patients with faecal incontinence resistant to conservative treatment but improved after percutaneous tibial nerve neuromodulation were treated with sacral nerve neuromodulation in 2014. Quality of Life questionnaires were used in order to determine the impact of faecal incontinence on everyday life before and after the implantation of the stimulator. To evaluate the functional state, Wexner's questionnaires were applied. Bowel movement diary was used to detect the improvement of faecal continence before and after temporary and permanent neuromodulation. The data were analyzed using a Statistical Package for Social Sciences program (SPSS, version 22.0). All values were given as mean ± SD. P-values less than 0.05 were accepted to indicate statistical significance. Both patients had a reduction in episodes of incontinence and soiling during a 3 week temporary nerve stimulation period as well as during 3 week followup after permanent stimulator implantation. Statistically significant elevation of faecal urgency frequency (p=0.031) was observed during temporary nerve stimulation. Reduction of episodes of faecal incontinence (p=0.001) and soiling (p=0.000) was observed after permanent stimulator implantation. Both patients presented an improvement in lifestyle, coping, depression and embarrassment as well as an improvement in functional state 3 weeks after the beginning of sacral nerve stimulation. Conclusions: The first results of sacral neuromodulation in patients with faecal incontinence are excellent and very promising.

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Cost‐effectiveness analysis of sacral neuromodulation for faecal incontinence in the Netherlands

Abstract: The study demonstrated that introducing SNM in the surgical management algorithm for faecal incontinence was both more effective and less costly than DGP or ABS without SNM. This justifies adequate funding for SNM for patients with faecal incontinence.

Cited by 18 publications

References 22 publications

Cost-effectiveness of sacral nerve stimulation and percutaneous tibial nerve stimulation for faecal incontinence

Cost-effectiveness of sacral nerve stimulation and percutaneous tibial nerve stimulation for faecal incontinence

Sacral nerve stimulation for faecal incontinence and constipation: a European consensus statement

Sacral Neuromodulation for the Treatment of Faecal Incontinence: First Steps in Lithuania

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