title: A cost-effectiveness analysis of delayed sphincteroplasty for anal sphincter injury.
abstract: OBJECTIVE
  Anal-sphincter injury may result in faecal incontinence. Sphincteroplasty is usually performed as a primary (immediate) procedure. Delayed sphincteroplasty (DS) can be performed if there is significant trauma or soiling, if the primary procedure has failed, and if the injury was not recognized initially. This study aimed to determine the cost to patient and health service in the event a DS is performed.
  
  
  METHODS
  Patients with anal-sphincter-injury who underwent primary sphincteroplasty (PS)/DS were identified from the published literature (primary, n = 103; delayed, n = 777) using Medline, Embase, Ovid and Cochrane databases for studies published between 1976 and 2006. Studies included described at least one of the measured outcomes--probability of functional success/failure and quality of life (QOL). An economic model was constructed and decision analysis performed using a decision tree based on a Markov process. Main outcomes were quality-adjusted-life-years (QALYs) gained from each strategy, costs incurred and incremental cost-effectiveness ratio (ICER) over a 10- and 15-year time horizon.
  
  
  RESULTS
  Over 10 years, primary sphincteroplasty (PS) produced a gain of 5.72 QALYs for an estimated 2750 pounds, giving an ICER of 487 pounds per QALY. DS produced a gain of 3.73 QALYs for a cost of 2667 pounds, giving an ICER of 719 pounds per QALY. Both procedures fell below the 10,000 pounds per QALY willingness-to-pay threshold, but PS produced the highest QALYs. Both procedures performed poorly beyond the 10-year mark.
  
  
  CONCLUSIONS
  If DS has to be performed, the resultant cost is greater with concurrently lower QALYs gained. Successful PS substantially improves QOL and reduces overall cost-of-treatment.
authors: Department of Biosurgery and Surgical Technology, St Mary's Hospital, Imperial College, London, UK.
authors: E K
authors: EK
authors: Tan
authors: M
authors: M
authors: Jacovides
authors: V
authors: V
authors: Khullar
authors: T-G
authors: TG
authors: Teoh
authors: R J
authors: RJ
authors: Fernando
authors: P P
authors: PP
authors: Tekkis
mesh_terms: D000328:Adult; D001003:Anal Canal / Q000293:injuries / Q000601:surgery*; D017281:Cost of Illness; D003362:Cost-Benefit Analysis; D005242:Fecal Incontinence / Q000601:surgery*; D005260:Female; D006801:Humans; D008297:Male; D008390:Markov Chains; D008875:Middle Aged; D019057:Quality-Adjusted Life Years; D019651:Plastic Surgery Procedures / Q000191:economics*; D013997:Time Factors; D055815:Young Adult