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. 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

Anton Emmanuel  1 , Gayathri Kumar  2 , Peter Christensen  3 , Stuart Mealing  2 , Zenia M Størling  4 , Frederikke Andersen  4 , Steven Kirshblum  5
Affiliations

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

Anton Emmanuel et al. PLoS One. .

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.

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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.

Figures

Fig 1
Fig 1. Data and Markov model overview.
The boxes represent the health states that a neurogenic patient can transition between after having failed standard bowel care (SBC) before and after 2007. SBC alone. After having failed SBC >6 months, a patient can either a) Resume SBC, b) Progress to SNS/SARS/ACE or d) Progress to stoma (absorbing state). TAI in combination with SBC. After having failed SBC >6 months, a patient can either a) Initiate Peristeen TAI, b) Resume SBC, c) Progress to SNS/SARS/ACE or d) Progress to stoma. The model assumes that patients do not transition directly from SBC/TAI to stoma. Transition probabilities have been obtained for each 6-month model cycle using GoalSeek in Excel.
Fig 2
Fig 2. Tornado diagram.
Fig 3
Fig 3. Cost-effectiveness plane.
WTP: Willingness to pay: linear threshold corresponds to the WTP value used by NICE in making reimbursement decisions (£30.000 per QALY gained). Each quadrant corresponds to one incremental cost option (cost saving, not cost saving) and one incremental benefit option (more/less benefit than comparator therapy).
See this image and copyright information in PMC

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