Clinical and cost effectiveness of sacral nerve stimulation for faecal incontinence

Background: Sacral nerve stimulation (SNS) has better results and safety than other surgical procedures for faecal incontinence. This prospective study assessed the clinical effectiveness and costs of SNS at a single centre. Methods: Patients who had experienced one or more episodes of faecal incont...

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Bibliographic Details
Published in:British journal of surgery 2008-08, Vol.95 (8), p.1037-1043
Main Authors: Muñoz-Duyos, A., Navarro-Luna, A., Brosa, M., Pando, J. A., Sitges-Serra, A., Marco-Molina, C.
Format: Article
Language:English
Subjects:
Adult
Aged
Biological and medical sciences
Cost-Benefit Analysis
Fecal Incontinence - economics
Fecal Incontinence - therapy
Female
Follow-Up Studies
Gastroenterology. Liver. Pancreas. Abdomen
General aspects
Humans
Male
Medical sciences
Middle Aged
Other diseases. Semiology
Prospective Studies
Quality of Life
Sacrum - innervation
Stomach. Duodenum. Small intestine. Colon. Rectum. Anus
Surveys and Questionnaires
Transcutaneous Electric Nerve Stimulation - economics
Transcutaneous Electric Nerve Stimulation - standards
Treatment Outcome
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Summary:Background: Sacral nerve stimulation (SNS) has better results and safety than other surgical procedures for faecal incontinence. This prospective study assessed the clinical effectiveness and costs of SNS at a single centre. Methods: Patients who had experienced one or more episodes of faecal incontinence were studied for up to 5 years by continence diary, anorectal manometry and quality of life questionnaires. Direct medical costs were calculated and the cost‐effectiveness of the treatment was analysed. Results: Fifty‐seven percutaneous nerve evaluations were performed in 47 patients between June 1999 and February 2006; 29 patients underwent permanent implantation. After a median follow‐up of 34·7 (range 2·3–81·2) months, 25 of the 29 patients had a significant reduction in incontinence episodes; 14 patients were in complete remission. At 3‐year follow‐up, the mean reduction in incontinence episodes was 89 per cent. No change was observed in anal manometric values. Patients reported a significant improvement in quality of life. The introduction of SNS has an incremental cost‐effectiveness ratio, below the accepted Spanish threshold. Conclusion: The introduction of SNS to the management of faecal incontinence within the Spanish setting is both effective and efficient. Copyright © 2008 British Journal of Surgery Society Ltd. Published by John Wiley & Sons, Ltd. Expensive but effective
ISSN:0007-1323
1365-2168
DOI:10.1002/bjs.6140