Economic consequences of an implanted neuroprosthesis for bladder and bowel management.
OBJECTIVE
To determine whether an implanted neuroprosthesis for bladder and bowel management is less costly than conventional techniques.


METHODS
Retrospective cost-identification analysis with comparison before and after implantation of the neuroprosthesis.


METHODS
Life-care planning interviews in patients' homes.


METHODS
Twelve patients with complete suprasacral spinal cord injuries and neurogenic bladder and bowel.


METHODS
Implantation of a neuroprosthesis for electric stimulation of the sacral nerves and posterior sacral rhizotomy.


METHODS
Annual costs of bladder and bowel care with and without the neuroprosthesis, projected over 10 years.


RESULTS
Bladder and bowel care costs were reduced by over 80%, from a median of 8152 dollars a year for conventional care to a median of 948 dollars a year. With the neuroprosthesis, median annual costs for bladder supplies were reduced from 3368 dollars to 58 dollars; for medications, from 1866 dollars to 108 dollars; for medical care, from 656 dollars to 96 dollars; and for bowel care supplies, from 205 dollars to 87 dollars. After 5 years, the cumulative costs of treatment with the neuroprosthesis, including the cost of the device and its implantation and maintenance, equaled those of conventional care. Thereafter, savings from the implanted neuroprosthesis are projected to increase progressively throughout the patient's life.


CONCLUSIONS
A neuroprosthesis implant with posterior rhizotomy greatly reduces the cost of managing the neurogenic bladder and bowel.
Creasey
G H
GH
Louis Stokes VA Medical Center, MetroHealth Medical Center and Case Western Reserve University, Cleveland, OH 44109, USA. ghc@po.cwru.edu
Dahlberg
J E
JE
D000328:Adult; D003248:Constipation / Q000209:etiology / Q000534:rehabilitation*; D017281:Cost of Illness; D003365:Costs and Cost Analysis; D004558:Electric Stimulation; D004567:Electrodes, Implanted; D005242:Fecal Incontinence / Q000209:etiology / Q000534:rehabilitation*; D005260:Female; D006699:Home Care Services / Q000191:economics*; D006801:Humans; D008297:Male; D008875:Middle Aged; D019736:Prostheses and Implants / Q000191:economics*; D015203:Reproducibility of Results; D012189:Retrospective Studies; D019051:Rhizotomy; D013119:Spinal Cord Injuries / Q000150:complications*; D001750:Urinary Bladder, Neurogenic / Q000209:etiology / Q000534:rehabilitation*