title: Clinical and economic impact of using macrogol 3350 plus electrolytes in an outpatient setting compared to enemas and suppositories and manual evacuation to treat paediatric faecal impaction based on actual clinical practice in England and Wales.
abstract: OBJECTIVE
  To estimate the clinical and economic impact of using macrogol 3350 plus electrolytes (macrogol 3350; Movicol; Movicol Paediatric Plain) in an outpatient setting compared to enemas and suppositories and manual evacuation to treat paediatric faecal impaction.
  
  
  METHODS
  A chart review was undertaken to extract clinical outcomes and resource use from the case notes of a cohort of children aged 2-11 years with faecal impaction who initially received either macrogol 3350 (in an outpatient setting) or enemas and suppositories or manual evacuation for initial disimpaction. Five centres across England and Wales participated in the study. These data were used to inform a decision model which depicted the management of children during the disimpaction phase and for a period of 12 weeks following initial disimpaction. Unit resource costs at 2005/2006 prices were applied to the resource utilisation estimates within the model, enabling the incremental costs and consequences of using macrogol 3350 in an outpatient setting, compared to the other treatments, to be estimated.
  
  
  RESULTS
  112 patients treated with macrogol 3350, 101 who received enemas and suppositories and 11 who underwent a manual evacuation were eligible for analysis. Ninety-seven per cent of children treated with macrogol 3350 were successfully disimpacted within 5 days, compared to 73% of those who received enemas and suppositories and 89% of those who underwent a manual evacuation (p < 0.001). There were no significant differences in reported adverse events between the different treatments for disimpaction, with the exception of vomiting which was significantly higher among those who underwent a manual evacuation (18% versus 2% with the other treatments; p < 0.01). There were no significant differences in the number of clinician outpatient visits between treatments. However, macrogol 3350-treated patients had significantly fewer hospital admissions than those who received the other interventions (0.1 versus 1.4 and 1.0 for enemas and suppositories and manual evacuation respectively; p < 0.05) and occupied fewer bed days. The total NHS cost of disimpaction and subsequent maintenance of children initially treated with macrogol 3350 was estimated to be 694 pounds sterling (95% CI: 496 pounds sterling; 892 pounds sterling). This compared with 2759 pounds sterling (95% CI: 1266 pounds sterling; 4252 pounds sterling) and 2333 pounds sterling (95% CI: 1609 pounds sterling; 3058 pounds sterling) for those who initially received enemas and suppositories or underwent a manual evacuation, respectively. Hence, using macrogol 3350 instead of enemas and suppositories and manual evacuation to disimpact the whole annual cohort of faecally impacted children aged 2-11 years in England could potentially reduce annual NHS expenditure on this condition by 59% (5 million pounds sterling) and reduce the annual number of paediatric hospital admissions for this condition by 92% (4330).
  
  
  CONCLUSIONS
  Within the limitations of our model, macrogol 3350 affords the NHS a clinically effective and cost-effective treatment for the disimpaction of children suffering from faecal impaction compared to enemas and suppositories or a manual evacuation, and has the potential to release healthcare resources for alternative use within the system.
authors: Catalyst Health Economics Consultants, Northwood, Middlesex, UK. julian.guest@catalyst-health.co.uk
authors: Julian F
authors: JF
authors: Guest
authors: David C A
authors: DC
authors: Candy
authors: John P
authors: JP
authors: Clegg
authors: Di
authors: D
authors: Edwards
authors: Marianne T
authors: MT
authors: Helter
authors: Anne K
authors: AK
authors: Dale
authors: John
authors: J
authors: Fell
authors: Michael
authors: M
authors: Cosgrove
authors: Geoffrey
authors: G
authors: Debelle
mesh_terms: D002648:Child; D002675:Child, Preschool; D004573:Electrolytes / Q000008:administration & dosage / Q000627:therapeutic use*; D004733:Enema; D004739:England; D005244:Fecal Impaction / Q000188:drug therapy / Q000191:economics / Q000628:therapy*; D006801:Humans; D011092:Polyethylene Glycols / Q000627:therapeutic use*; D013488:Suppositories; D014852:Wales
chemical_list: D004573:Electrolytes; D013488:Suppositories; D011092:Polyethylene Glycols