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. 2024 Mar;78(3):608-613.
doi: 10.1002/jpn3.12118. Epub 2024 Jan 15.

Percutaneous electrical nerve field stimulation for adolescents with irritable bowel syndrome: Cost-benefit and cost-minimization analysis

Eric Shah  1 , Shanti Eswaran  1 , Kimberly Harer  1 , Allen Lee  1 , Borko Nojkov  1 , Prashant Singh  1 , William D Chey  1
Affiliations

Percutaneous electrical nerve field stimulation for adolescents with irritable bowel syndrome: Cost-benefit and cost-minimization analysis

Eric Shah et al. J Pediatr Gastroenterol Nutr. 2024 Mar.

Abstract

Abdominal pain drives significant cost for adolescents with irritable bowel syndrome (IBS). We performed an economic analysis to estimate cost-savings for patients' families and healthcare insurance, and health outcomes, based on abdominal pain improvement with percutaneous electrical nerve field stimulation (PENFS) with IB-Stim® (Neuraxis). We constructed a Markov model with a 1-year time horizon comparing outcomes and costs with PENFS versus usual care without PENFS. Clinical outcomes were derived from a sham-controlled double-blind trial of PENFS for adolescents with IBS. Costs/work-productivity impact for parents were derived from appropriate observational cohorts. PENFS was associated with 18 added healthy days over 1 year of follow-up, increased annual parental wages of $5,802 due to fewer missed work days to care for the child, and $4744 in cost-savings to insurance. Percutaneous electrical field nerve stimulation for adolescents with IBS appears to yield significant cost-savings to patients' families and insurance.

Keywords: comparative effectiveness research; costs and cost analysis; diagnostic testing; insurance; medical devices.

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Conflict of interest statement

Potential competing interests: Dr. Shah consulted for Ardelyx, GI Supply, Mahana, Neuraxis, Salix, Sanofi, and Takeda. Dr. Chey is a consultant for Allergan, Biomerica, IM Health, Ironwood, Outpost, QOL Medical, Ritter, Salix, Urovant and has research grants from Commonwealth Diagnostics, Ironwood, QOL Medical, Salix, Urovant, Vibrant, and Zespri. Dr. Shah and Dr. Chey hold a patent on an investigational anorectal function testing device with the Regents of the University of Michigan. The other authors have no disclosures.

Figures

Figure 1:
Figure 1:
Model diagram.
Figure 2:
Figure 2:
PENFS appears cost-saving to insurers and patients for IBS-related abdominal pain.
Figure 3:
Figure 3:
In probabilistic sensitivity analysis, PENFS appears cost-saving across contemporary willingness-to-pay thresholds from an insurer perspective (Panel B), with similar results from a patient perspective (not shown).
Figure 4:
Figure 4:
The threshold value of PENFS depends on expectations of downstream cost-savings that are affected by durability. The average IBS-related healthcare cost is $7,962.11 per year among patients referred to pediatric gastroenterology inclusive of diagnostic tests, treatments, and visits.
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