Cost-effectiveness analysis of sacral neuromodulation for faecal incontinence in The Netherlands

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Abstract

AIM: Sacral neuromodulation (SNM) plays a major part in the algorithm of management of faecal incontinence, but there are limited data on its cost-effectiveness. This study aimed to analyse this and the quality-adjusted life-years (QALYs) associated with two different treatment algorithms. The first (SNM-) included use of an artificial sphincter [dynamic graciloplasty (DGP) (50%) and artificial bowel sphincter (ABS) (50%)]. The second (SNM+) included SNM (80% of cases) and artificial sphincter (DGP 10%; ABS 10%) The incidence of sphincteroplasty was assumed to be equal in both algorithms. METHOD: A Markov model was developed. A hypothetical cohort of patients was run through both strategies of the model. A mailed EuroQoL-5D questionnaire was used to determine health-related quality of life. Costs were reproduced from the Maastricht University Medical Centre prospective faecal incontinence database. The time scale of the analysis was 5 years. RESULTS: The former treatment protocol cost euro22,651 per patient and the latter, after the introduction of SNM, cost euro16,473 per patient. The former treatment protocol resulted in a success rate of 0.59 after 5 years, whereas with the introduction of SNM this was 0.82. Adhering to the former treatment protocol yielded 4.14 QALYs and implementing the latter produced 4.21 QALYs. CONCLUSION: 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.
Original languageEnglish
Pages (from-to)e807-e814
Number of pages8
JournalColorectal Disease
Volume14
Issue number12
DOIs
Publication statusPublished - Dec 2012

Keywords

  • Cost-effectiveness
  • SNM
  • faecal incontinence
  • DGP
  • ABS
  • NERVE-STIMULATION
  • SPHINCTER

Cite this

@article{5b8b7cccff9e4f5985376161e9ef8954,
title = "Cost-effectiveness analysis of sacral neuromodulation for faecal incontinence in The Netherlands",
abstract = "AIM: Sacral neuromodulation (SNM) plays a major part in the algorithm of management of faecal incontinence, but there are limited data on its cost-effectiveness. This study aimed to analyse this and the quality-adjusted life-years (QALYs) associated with two different treatment algorithms. The first (SNM-) included use of an artificial sphincter [dynamic graciloplasty (DGP) (50{\%}) and artificial bowel sphincter (ABS) (50{\%})]. The second (SNM+) included SNM (80{\%} of cases) and artificial sphincter (DGP 10{\%}; ABS 10{\%}) The incidence of sphincteroplasty was assumed to be equal in both algorithms. METHOD: A Markov model was developed. A hypothetical cohort of patients was run through both strategies of the model. A mailed EuroQoL-5D questionnaire was used to determine health-related quality of life. Costs were reproduced from the Maastricht University Medical Centre prospective faecal incontinence database. The time scale of the analysis was 5 years. RESULTS: The former treatment protocol cost euro22,651 per patient and the latter, after the introduction of SNM, cost euro16,473 per patient. The former treatment protocol resulted in a success rate of 0.59 after 5 years, whereas with the introduction of SNM this was 0.82. Adhering to the former treatment protocol yielded 4.14 QALYs and implementing the latter produced 4.21 QALYs. CONCLUSION: 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.",
keywords = "Cost-effectiveness, SNM, faecal incontinence, DGP, ABS, NERVE-STIMULATION, SPHINCTER",
author = "{van Wunnik}, B.P. and R.G.J. Visschers and {van Asselt}, A.D.I. and C.G.M.I. Baeten",
year = "2012",
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doi = "10.1111/codi.12002",
language = "English",
volume = "14",
pages = "e807--e814",
journal = "Colorectal Disease",
issn = "1462-8910",
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}

Cost-effectiveness analysis of sacral neuromodulation for faecal incontinence in The Netherlands. / van Wunnik, B.P.; Visschers, R.G.J.; van Asselt, A.D.I.; Baeten, C.G.M.I.

In: Colorectal Disease, Vol. 14, No. 12, 12.2012, p. e807-e814.

Research output: Contribution to journalArticleAcademicpeer-review

TY - JOUR

T1 - Cost-effectiveness analysis of sacral neuromodulation for faecal incontinence in The Netherlands

AU - van Wunnik, B.P.

AU - Visschers, R.G.J.

AU - van Asselt, A.D.I.

AU - Baeten, C.G.M.I.

PY - 2012/12

Y1 - 2012/12

N2 - AIM: Sacral neuromodulation (SNM) plays a major part in the algorithm of management of faecal incontinence, but there are limited data on its cost-effectiveness. This study aimed to analyse this and the quality-adjusted life-years (QALYs) associated with two different treatment algorithms. The first (SNM-) included use of an artificial sphincter [dynamic graciloplasty (DGP) (50%) and artificial bowel sphincter (ABS) (50%)]. The second (SNM+) included SNM (80% of cases) and artificial sphincter (DGP 10%; ABS 10%) The incidence of sphincteroplasty was assumed to be equal in both algorithms. METHOD: A Markov model was developed. A hypothetical cohort of patients was run through both strategies of the model. A mailed EuroQoL-5D questionnaire was used to determine health-related quality of life. Costs were reproduced from the Maastricht University Medical Centre prospective faecal incontinence database. The time scale of the analysis was 5 years. RESULTS: The former treatment protocol cost euro22,651 per patient and the latter, after the introduction of SNM, cost euro16,473 per patient. The former treatment protocol resulted in a success rate of 0.59 after 5 years, whereas with the introduction of SNM this was 0.82. Adhering to the former treatment protocol yielded 4.14 QALYs and implementing the latter produced 4.21 QALYs. CONCLUSION: 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.

AB - AIM: Sacral neuromodulation (SNM) plays a major part in the algorithm of management of faecal incontinence, but there are limited data on its cost-effectiveness. This study aimed to analyse this and the quality-adjusted life-years (QALYs) associated with two different treatment algorithms. The first (SNM-) included use of an artificial sphincter [dynamic graciloplasty (DGP) (50%) and artificial bowel sphincter (ABS) (50%)]. The second (SNM+) included SNM (80% of cases) and artificial sphincter (DGP 10%; ABS 10%) The incidence of sphincteroplasty was assumed to be equal in both algorithms. METHOD: A Markov model was developed. A hypothetical cohort of patients was run through both strategies of the model. A mailed EuroQoL-5D questionnaire was used to determine health-related quality of life. Costs were reproduced from the Maastricht University Medical Centre prospective faecal incontinence database. The time scale of the analysis was 5 years. RESULTS: The former treatment protocol cost euro22,651 per patient and the latter, after the introduction of SNM, cost euro16,473 per patient. The former treatment protocol resulted in a success rate of 0.59 after 5 years, whereas with the introduction of SNM this was 0.82. Adhering to the former treatment protocol yielded 4.14 QALYs and implementing the latter produced 4.21 QALYs. CONCLUSION: 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.

KW - Cost-effectiveness

KW - SNM

KW - faecal incontinence

KW - DGP

KW - ABS

KW - NERVE-STIMULATION

KW - SPHINCTER

U2 - 10.1111/codi.12002

DO - 10.1111/codi.12002

M3 - Article

VL - 14

SP - e807-e814

JO - Colorectal Disease

JF - Colorectal Disease

SN - 1462-8910

IS - 12

ER -