Cost-effectiveness of transanal irrigation versus conservative bowel management for spinal cord injury patients

Abstract

Study design: Cost-effectiveness analysis following international guidelines and taking the societal viewpoint. Objectives: To estimate the cost-effectiveness of transanal irrigation using a self-administered irrigation system when compared with conservative bowel management. Setting: A randomized clinical trial was conducted at five spinal centres situated in Denmark, Germany, Italy, United Kingdom and Sweden. Estimates of resources and unit costs were made for the German health care system. Methods: Efficacy outcomes were drawn from a randomized controlled trial conducted in [2003][2004][2005]. Adult spinal cord-injured patients with neurogenic bowel dysfunction were randomized to 10 weeks with either transanal irrigation using Peristeen Anal Irrigation or to conservative bowel management. Costs were calculated based on results from the clinical trial and on 24 interviews conducted in Germany. Unit costs were obtained from the Federal Statistical Office Germany and product list prices. Results: When comparing outcome measures at termination, transanal irrigation significantly reduced symptoms of neurogenic bowel dysfunction. Product-related costs were higher for transanal irrigation using the self-administered system; however, costs for a carer to help with bowel management and changes/washing due to leakage were lower. For transanal irrigation, costs associated with urinary tract infections and patient time spent were reduced. Thus, the total cost to society is lower when patients use transanal irrigation. The results were shown to be robust in the sensitivity analysis. Conclusion: Transanal irrigation using a self-administered system reduces symptoms of neurogenic bowel dysfunction and results in a lower total cost to society than conservative bowel management. Sponsorship: The study was supported by Coloplast A/S.

Clinical Practice Guideline: Irritable bowel syndrome with constipation and functional constipation in the adult

“…These encouraging results have been subsequently confirmed by an Italian multicenter study, which concluded it may be considered as the treatment of choice for this type of patients (145). Furthermore, this therapy is cost-effective when compared to conservative management (145,146).…”

Review of the efficacy and safety of transanal irrigation for neurogenic bowel dysfunction

“…51 Although product-related costs were higher with TAI, this was offset by lower costs for a caregiver to help with bowel management and changes/washing due to leakage, as well lower costs associated with urinary tract infections, and less time spent by the patient on bowel management. 51 …”

Long-term outcome and safety of transanal colonic irrigation for neurogenic bowel dysfunction

“…Although gender, predominant symptom and colonic transit time were significantly associated with successful outcome, we would not recommend patient selection for TAI based only on these parameters. As TAI is a reversible safe treatment that enhances QoL both short term 18 and long term and has also recently been shown to be cost-effective for society compared with conservative bowel management, 22 we suggest that a trial and error strategy for the introduction of TAI to patients with NBD is used until more solid knowledge about factors associated with a positive outcome of TAI is gained from a prospective multicentre database. However, to some patients it may be an advantage to choose surgical treatment modalities earlier if significant practical problems with TAI are encountered.…”