Outcome and cost analysis of sacral nerve stimulation for faecal incontinence.
BACKGROUND
Sacral nerve stimulation (SNS) may be successful in treating incapacitating faecal incontinence. The technique is expensive, and no cost analysis is currently available. The aim of this study was to assess clinical outcome and analyse cost-effectiveness.


METHODS
Thirty-six consecutive patients underwent a two-stage SNS procedure. Outcome parameters and real costs were assessed prospectively.


RESULTS
SNS was tested successfully in 33 of 36 patients, and 31 patients were stimulated permanently. In the first stage, eight of 36 patients reported minor complications (pain, infection or electrode dislocation), resulting in a cost of euro 4053 (range euro 2838-7273) per patient. For the second stage (permanent stimulation), eight of 33 patients had an infection, pain or loss of effectiveness, resulting in a cost of euro 11,292 (range euro 7406-20,274) per patient. Estimated costs for further follow-up were euro 997 per year. The 5-year cumulative cost for SNS was euro 22,150 per patient, compared with euro 33,996 for colostomy, euro 31,590 for dynamic graciloplasty and euro 3234 for conservative treatment.


CONCLUSIONS
SNS is a highly cost-effective treatment for faecal incontinence. Options for further reduction of SNS costs include strict patient selection, treatment in an outpatient setting and using cheaper devices.
Hetzer
F H
FH
Division of Visceral and Transplantation Surgery, University Hospital of Zurich, Ramistrasse 100, CH 8091 Zurich, Switzerland. franc.hetzer@bluewin.ch
Bieler
A
A
Hahnloser
D
D
Löhlein
F
F
Clavien
P-A
PA
Demartines
N
N
D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D003362:Cost-Benefit Analysis; D004599:Electric Stimulation Therapy / Q000191:economics* / Q000379:methods; D004567:Electrodes, Implanted; D005242:Fecal Incontinence / Q000191:economics / Q000628:therapy*; D005260:Female; D006801:Humans; D008160:Lumbosacral Plexus; D008297:Male; D008875:Middle Aged; D004561:Transcutaneous Electric Nerve Stimulation / Q000191:economics / Q000379:methods; D016896:Treatment Outcome