Journal
THERAPEUTIC ADVANCES IN GASTROENTEROLOGY
Volume 11, Issue -, Pages -Publisher
SAGE PUBLICATIONS LTD
DOI: 10.1177/1756284818802562
Keywords
cost-effectiveness; faecal incontinence; health economics; percutaneous tibial nerve stimulation; sacral nerve stimulation
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Funding
- National Institutes of Health Research (NIHR) [PB-PG-0909-20150] Funding Source: National Institutes of Health Research (NIHR)
- Department of Health [PB-PG-0909-20150] Funding Source: Medline
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Background: Subcutaneous sacral nerve stimulation is recommended by the United Kingdom (UK) National Institute for Health and Care Excellence (NICE) as a second-line treatment for patients with faecal incontinence who failed conservative therapy. Sacral nerve stimulation is an invasive procedure associated with complications and reoperations. This study aimed to investigate whether delivering less invasive and less costly percutaneous tibial nerve stimulation prior to sacral nerve stimulation is cost-effective. Methods: A decision analytic model was developed to estimate the cost-effectiveness of percutaneous tibial nerve stimulation with subsequent subcutaneous sacral nerve stimulation versus subcutaneous sacral nerve stimulation alone. The model was populated with effectiveness data from systematic reviews and cost data from randomized studies comparing both procedures in a UK National Health Service (NHS) setting. Results: Offering percutaneous tibial nerve stimulation prior to sacral nerve stimulation (compared with delivering sacral nerve stimulation straight away) was both more effective and less costly in all modeled scenarios. The estimated savings from offering percutaneous tibial nerve stimulation first were 662- pound 5,697 pound per patient. The probability of this strategy being cost-effective was around 80% at 20,000- pound 30,000 pound per quality-adjusted life-year (QALY). Conclusion: Our analyses suggest that offering patients percutaneous tibial nerve stimulation prior to sacral nerve stimulation can be both cost-effective and cost-saving in the treatment of faecal incontinence.
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