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PLoS One. 2016 Aug 24;11(8):e0159394. doi: 10.1371/journal.pone.0159394. eCollection 2016.

Long-Term Cost-Effectiveness of Transanal Irrigation in Patients with Neurogenic Bowel Dysfunction.

Author information

1
GI Physiology Unit, University College London Hospital, London, United Kingdom.
2
ICON Health Economics, Oxford, United Kingdom.
3
Pelvic Floor Unit, Aarhus University Hospital, Aarhus, Denmark.
4
Coloplast A/S, Humlebaek, Denmark.
5
Kessler Institute for Rehabilitation, Rutgers New Jersey Medical School, Newark, New Jersey, United States of America.

Abstract

BACKGROUND:

People suffering from neurogenic bowel dysfunction (NBD) and an ineffective bowel regimen often suffer from fecal incontinence (FI) and related symptoms, which have a huge impact on their quality of life. In these situations, transanal irrigation (TAI) has been shown to reduce these symptoms and improve quality of life.

AIM:

To investigate the long-term cost-effectiveness of initiating TAI in patients with NBD who have failed standard bowel care (SBC).

METHODS:

A deterministic Markov decision model was developed to project the lifetime health economic outcomes, including quality-adjusted life years (QALYs), episodes of FI, urinary tract infections (UTIs), and stoma surgery when initiating TAI relative to continuing SBC. A data set consisting of 227 patients with NBD due to spinal cord injury (SCI), multiple sclerosis, spina bifida and cauda equina syndrome was used in the analysis. In the model a 30-year old individual with SCI was used as a base-case. A probabilistic sensitivity analysis was applied to evaluate the robustness of the model.

RESULTS:

The model predicts that a 30-year old SCI patient with a life expectancy of 37 years initiating TAI will experience a 36% reduction in FI episodes, a 29% reduction in UTIs, a 35% reduction in likelihood of stoma surgery and a 0.4 improvement in QALYs, compared with patients continuing SBC. A lifetime cost-saving of £21,768 per patient was estimated for TAI versus continuing SBC alone.

CONCLUSION:

TAI is a cost-saving treatment strategy reducing risk of stoma surgery, UTIs, episodes of FI and improving QALYs for NBD patients who have failed SBC.

PMID:
27557052
PMCID:
PMC4996513
DOI:
10.1371/journal.pone.0159394
[Indexed for MEDLINE]
Free PMC Article

Conflict of interest statement

FA and ZS are employees of Coloplast A/S who have funded the study. AE, PC and SK are occasionally used as KOLs for advisory boards at Coloplast A/S. The authors confirm that this does not alter the authors' adherence to PLOS ONE policies on sharing data and materials.

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