Cost‐effectiveness of sacral neuromodulation for chronic refractory constipation in children and adolescents: a Markov model analysis

Wilt, A. A. van der; Groenewoud, H. H. M.; Benninga, Marc A.; Dirksen, Carmen D.; Baeten, C. G. M. I.; Bouvy, Nicole D.; Melenhorst, Jarno; Breukink, Stéphanie O.

doi:10.1111/codi.13869

Cited by 8 publications

(7 citation statements)

References 28 publications

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“…This should be interpreted with caution as it was assumed that the effect of SNM remained unchanged. An excluded full‐text record assessed the cost‐effectiveness of SNM in children and adolescents with mixed FC subtypes and concluded that, from a healthcare perspective with a time horizon of 3 years, SNM might be a cost‐effective treatment option when compared with conservative treatment [45]. A mean ICER of €12 328 per QALY was reported in the base case analysis and ICERs ranged from €6422 per QALY to €36 652 per QALY based on sensitivity analyses [45].…”

Section: Discussionmentioning

confidence: 99%

Effectiveness, safety and cost‐effectiveness of sacral neuromodulation for idiopathic slow‐transit constipation: a systematic review

Heemskerk,

van der Wilt,

Penninx

et al. 2024

Colorectal Disease

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AimSacral neuromodulation (SNM) is a minimally invasive treatment option for functional constipation. Evidence regarding its effectiveness is contradictory, driven by heterogeneous study populations and designs. The aim of this study was to assess the effectiveness, safety and cost‐effectiveness of SNM in children and adults with refractory idiopathic slow‐transit constipation (STC).MethodOVID Medline, OVID Embase, Cochrane Library, the KSR Evidence Database, the NHS Economic Evaluation Database and the International HTA Database were searched up to 25 May 2023. For effectiveness outcomes, randomized controlled trials (RCTs) were selected. For safety outcomes, all study designs were selected. For cost‐effectiveness outcomes, trial‐ and model‐based economic evaluations were selected for review. Study selection, risk of bias and quality assessment, and data extraction were independently performed by two reviewers. For the intervention ‘sacral neuromodulation’ effectiveness outcomes included defaecation frequency and constipation severity. Safety and cost‐effectiveness outcomes were, respectively, adverse events and incremental cost‐effectiveness ratios.ResultsOf 1390 records reviewed, 67 studies were selected for full‐text screening. For effectiveness, one cross‐over and one parallel‐group RCT was included, showing contradictory results. Eleven studies on safety were included (four RCTs, three prospective cohort studies and four retrospective cohort studies). Overall infection rates varied between 0% and 22%, whereas reoperation rates varied between 0% and 29%. One trial‐based economic evaluation was included, which concluded that SNM was not cost‐effective compared with personalized conservative treatment at a time horizon of 6 months. The review findings are limited by the small number of available studies and the heterogeneity in terms of study populations, definitions of refractory idiopathic STC and study designs.ConclusionEvidence for the (cost‐)effectiveness of SNM in children and adults with refractory idiopathic STC is inconclusive. Reoperation rates of up to 29% were reported.

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Section: Discussionmentioning

confidence: 99%

Effectiveness, safety and cost‐effectiveness of sacral neuromodulation for idiopathic slow‐transit constipation: a systematic review

Heemskerk,

van der Wilt,

Penninx

et al. 2024

Colorectal Disease

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“…Moreover, financial costs associated with SNS treatment can be substantial. 31 We therefore stress that patients and their families should be educated about the possible risks of both treatments in order to make an informed decision.…”

Section: Discussionmentioning

confidence: 99%

Comparison of antegrade continence enema treatment and sacral nerve stimulation for children with severe functional constipation and fecal incontinence

Vriesman

Wang

Park

et al. 2020

Neurogastroenterology Motil

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Background To compare antegrade continence enema (ACE) treatment and sacral nerve stimulation (SNS) in children with intractable functional constipation (FC) and fecal incontinence (FI). Methods We performed a retrospective review of children 6‐18 years old with FC and FI treated with either ACE or SNS at our institution. We recorded symptoms at baseline, 6 months, 12 months, 24 months, and their most recent visit after starting treatment. We compared improvement in FI, bowel movement (BM) frequency, abdominal pain, laxative use, and complications. Patients were contacted to evaluate perceived benefit using the Glasgow Children's Benefit Inventory. Key Results We included 23 patients treated with ACE (52% female, median age 10 years) and 19 patients treated with SNS (74% female, median age 10 years). Improvement in FI was greater with SNS than ACE at 12 months (92.9% vs 57.1%, P = .03) and 24 months (100% vs 57.1%, P = .02). Improvement in BM frequency was greater with ACE, and children were more likely to discontinue laxatives at all follow‐up time points (all P < .05). Improvement in abdominal pain was greater with ACE at the most recent visit (P < .05). Rate of complications requiring surgery was similar between groups (26.3% vs 21.7%). Benefit was reported in 83.3% and 100% of ACE and SNS groups, respectively (NS). Conclusions and Inferences Although both ACE and SNS can lead to durable improvement in children with FC and FI, SNS appears more effective for FI and ACE more effective in improving BM frequency and abdominal pain and in discontinuation of laxatives.

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“…As was the case in all of these studies, for example, our model falls well short of representing clinical experience by failing to permit the possibility of recovering from a complication (in contrast, see van der Wilt et al (22) for an example of a cost modeling study in sacral neuromodulation that takes such recovery into account and the cost-utility analysis of sacral anterior root stimulation by Morlière et al ( 23) that integrates "reversible conditions," such as device failure, into its "irreversible states.") Annemans et al (9) describe the utility scores we adopted for this study, which were first published in 2009 (10) and which they (9) and Taylor et al (8) used in their studies, as "conservative" because in 2009 SCS equipment did not permit high-frequency stimulation, which Annemans et al believe has improved the effectiveness of SCS in treating low back pain.…”

Section: Strengths and Limitations Of Our Model And Its Inputsmentioning

confidence: 99%

Cost-Effectiveness Model Shows Superiority of Wireless Spinal Cord Stimulation Implantation Without a Separate Trial

North

Parihar

Spencer

et al. 2021

Neuromodulation: Technology at the Neural Interface

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Objective: We evaluated the cost-effectiveness of wireless spinal cord stimulation (Wireless SCS) with single stage "direct to permanent" implantation vs. screening with temporary electrodes and an external pulse generator followed by implantation of a system for long-term use (IPG SCS). Materials and Methods:We created a cost model that takes a 2019 United States (U.S.) payer perspective and is based on IPG SCS cost models for subjects with chronic back and/or leg pain. Our six-month decision tree includes the screening trial period (success ≥50% relief) and leads to various levels of pain relief with or without complications for IPG SCS and Wireless SCS and without complications for conventional medical management (CMM). Every three months in the follow-on 15-year Markov model (with costs and quality-adjusted life years discounted 3.5% annually), subjects remain stable or transition to deteriorated health or death. Subjects who fail SCS receive CMM. After 60 Markov cycles, a 100,000-sample simulation reveals the impact of maximum willingness-to-pay (WTP) from $10,000 to $100,000 per quality-adjusted life year on net monetary benefit (NMB). Sensitivity analyses considered the impact of the Wireless SCS screening success rate, Wireless SCS device cost, and IPG SCS device longevity.Results: Compared with IPG SCS, Wireless SCS offers higher clinical effectiveness at a lower cost and a higher NMB for our WTP thresholds and is, thus, dominant. Wireless SCS is also cost-effective compared with CMM. Results remain robust with 1) Wireless SCS screening success rates as low as 85% (dominant), 2) the cost of the Wireless SCS devices as high as $55,000 (cost-effective), and 3) IPG SCS devices lasting 12 years (dominant).

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Cost‐effectiveness of sacral neuromodulation for chronic refractory constipation in children and adolescents: a Markov model analysis

Abstract: Chronic constipation seriously affects the quality of life of children and adolescents. Preliminary evidence suggests that SNM can improve symptoms and quality of life at a reasonable cost.

Cited by 8 publications

References 28 publications

Effectiveness, safety and cost‐effectiveness of sacral neuromodulation for idiopathic slow‐transit constipation: a systematic review

Effectiveness, safety and cost‐effectiveness of sacral neuromodulation for idiopathic slow‐transit constipation: a systematic review

Comparison of antegrade continence enema treatment and sacral nerve stimulation for children with severe functional constipation and fecal incontinence

Cost-Effectiveness Model Shows Superiority of Wireless Spinal Cord Stimulation Implantation Without a Separate Trial

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