Affiliation:
1. General Surgery Service Hospital Reina Sofía de Tudela Tudela Spain
2. Department of Economics Public University of Navarre (UPNA) Pamplona Spain
3. Colorectal Surgery Unit Hospital Universitario de Navarra Pamplona Spain
Abstract
AbstractAimThe aim of this study was to evaluate the long‐term cost‐effectiveness of sacral neuromodulation in the treatment of severe faecal incontinence as compared with symptomatic management.MethodsIn the public health field, a micro‐costing evaluation method was conducted from the perspectives of the health system and the society. The incremental cost‐effectiveness ratio was used as a decision index, and we considered various scenarios to evaluate the impact of the cost of symptomatic management and percutaneous nerve evaluation success rate in its calculation. Clinical data were retrieved from a consecutive cohort of 93 patients with severe faecal incontinence undergoing sacral neuromodulation after a failure of conservative (pharmacological and biofeedback) and/or surgical (sphincteroplasty) first‐line treatments were considered.ResultsThe long‐term incremental cost‐effectiveness ratio comparing sacral neuromodulation versus symptomatic management was 14347€/QALY and 28523€/QALY from the societal and health service provider's perspectives, respectively. If the definitive pulse generator implant success rate was 100%, incremental cost‐effectiveness would correspond to 6831€/QALY and 16761€/QALY, respectively.ConclusionsSacral neuromodulation may be considered a cost‐effective technique in the long‐term treatment of severe faecal incontinence from the societal and health care sector perspectives. Improving patient selection and determining the predictive outcome factors for successful sacral neuromodulation in the treatment of faecal incontinence would improve cost‐effectiveness.