title: Cost-effectiveness analysis of sacral neuromodulation (SNM) with Interstim for fecal incontinence patients in Spain.
abstract: BACKGROUND
  Fecal incontinence (FI) is a condition with a high impact on the psychological and social life of healthy people. Interstim, the sacral neuromodulation (SNM) therapy, has shown higher effectiveness and safety rates than surgical procedures like dynamic graciloplasty or artificial anal sphincter in patients with intact anal sphincter (IAS) and after sphincteroplasty in patients with structurally deficient anal sphincter (SDAS).
  
  
  OBJECTIVE
  To assess the cost-effectiveness of FI management in two scenarios - with and without SNM - and to estimate the potential budget impact of its progressive introduction in the Spanish setting.
  
  
  METHODS
  Two decision analytical models were developed (IAS and SDAS patients) representing the possible clinical paths for each of the scenarios (with and without SNM), as well as its clinical and economic consequences in the mid-to long term with a Markov model. Clinical and resource use data were retrieved from the literature and validated by a clinician expert panel. Effectiveness was measured with both QALYs and symptom-free years (SFY). A 3% discount rate was used for future costs and benefits (time horizon = 5 years). Prevalence figures were combined with Interstim sales forecasts to estimate the total number of patients to receive therapy over the next 5 years and the associated budget impact.
  
  
  RESULTS
  The introduction of Interstim in the therapeutic management of FI has an associated cost-effectiveness of euro16 181 (IAS patients) and euro22 195 (SDAS patients) per QALY gained. The progressive introduction of Interstim in 75 to 100 patients/year will have an estimated budget impact of 0.1% of incremental costs in patients with FI.
  
  
  CONCLUSIONS
  Introducing Interstim in the management of FI in IAS and SDAS patients in the Spanish setting has shown to be an efficient measure with an incremental cost-effectiveness ratio below the accepted Spanish threshold (around euro35 000/QALY), and with a relatively low additional cost for the Spanish NHS.
authors.affiliation: Oblikue Consulting, SL, Barcelona, Spain. max.brosa@oblikue.com
authors.forename: Max
authors.initials: M
authors.lastname: Brosa
authors.forename: Arantxa
authors.initials: A
authors.lastname: Muñoz-Duyos
authors.forename: Albert
authors.initials: A
authors.lastname: Navarro-Luna
authors.forename: José Manuel
authors.initials: JM
authors.lastname: Rodriguez
authors.forename: David
authors.initials: D
authors.lastname: Serrano
authors.forename: Ramón
authors.initials: R
authors.lastname: Gisbert
authors.forename: Kristina
authors.initials: K
authors.lastname: Dziekan
authors.forename: J L
authors.initials: JL
authors.lastname: Segú
mesh_terms: D000465:Algorithms; D001003:Anal Canal / Q000294:innervation*; D003362:Cost-Benefit Analysis; D003661:Decision Support Techniques; D004599:Electric Stimulation Therapy / Q000191:economics* / Q000295:instrumentation; D004567:Electrodes, Implanted; D005242:Fecal Incontinence / Q000191:economics* / Q000523:psychology / Q000628:therapy*; D006801:Humans; D008390:Markov Chains; D018803:Models, Economic; D011788:Quality of Life; D019057:Quality-Adjusted Life Years; D013030:Spain