title: Outcome and cost analysis of sacral nerve modulation for treating urinary and/or fecal incontinence.
abstract: BACKGROUND
  Sacral nerve modulation (SNM) is an established treatment for urinary and fecal incontinence in patients for whom conservative management has failed.
  
  
  OBJECTIVE
  This study assessed the outcome and cost analysis of SNM compared to alternative medical and surgical treatments.
  
  
  METHODS
  Clinical outcome and cost-effectiveness analyses were performed in parallel with a prospective, multicenter cohort study that included 369 consecutive patients with urge urinary and/or fecal incontinence. The duration of follow-up was 24 months, and costs were estimated from the national health perspective. Cost-effectiveness outcomes were expressed as incremental costs per 50% of improved severity scores (incremental cost-effectiveness ratio).
  
  
  RESULTS
  The SNM significantly improved the continence status (P < 0.005) and quality of life (P < 0.05) of patients with urge urinary and/or fecal incontinence compared to alternative treatments. The average cost of SNM for urge urinary incontinence was ∈8525 (95% confidence interval, ∈6686-∈10,364; P = 0.001) more for the first 2 years compared to alternative treatments. The corresponding increase in cost for subjects with fecal incontinence was ∈6581 (95% confidence interval, ∈2077-∈11,084; P = 0.006). When an improvement of more than 50% in the continence severity score was used as the unit of effectiveness, the incremental cost-effectiveness ratio for SNM was ∈94,204 and ∈185,160 at 24 months of follow-up for urinary and fecal incontinence, respectively.
  
  
  CONCLUSIONS
  The SNM is a cost-effective treatment for urge urinary and/or fecal incontinence.
authors.affiliation: ADEN EA/IFR MP, Rouen University Hospital, France. annemarie.leroi@chu-rouen.fr
authors.forename: Anne-Marie
authors.initials: AM
authors.lastname: Leroi
authors.forename: Xavier
authors.initials: X
authors.lastname: Lenne
authors.forename: Benoît
authors.initials: B
authors.lastname: Dervaux
authors.forename: Emmanuel
authors.initials: E
authors.lastname: Chartier-Kastler
authors.forename: Brigitte
authors.initials: B
authors.lastname: Mauroy
authors.forename: Loïc Le
authors.initials: LL
authors.lastname: Normand
authors.forename: Philippe
authors.initials: P
authors.lastname: Grise
authors.forename: Jean-Luc
authors.initials: JL
authors.lastname: Faucheron
authors.forename: Yann
authors.initials: Y
authors.lastname: Parc
authors.forename: Paul-Antoine
authors.initials: PA
authors.lastname: Lehur
authors.forename: François
authors.initials: F
authors.lastname: Mion
authors.forename: Henri
authors.initials: H
authors.lastname: Damon
authors.forename: Xavier
authors.initials: X
authors.lastname: Barth
authors.forename: Albert
authors.initials: A
authors.lastname: Leriche
authors.forename: Christian
authors.initials: C
authors.lastname: Saussine
authors.forename: Laurent
authors.initials: L
authors.lastname: Guy
authors.forename: François
authors.initials: F
authors.lastname: Haab
authors.forename: Laurent
authors.initials: L
authors.lastname: Bresler
authors.forename: Jean-Pierre
authors.initials: JP
authors.lastname: Sarramon
authors.forename: Henri
authors.initials: H
authors.lastname: Bensadoun
authors.forename: Eric
authors.initials: E
authors.lastname: Rullier
authors.forename: Karem
authors.initials: K
authors.lastname: Slim
authors.forename: Igor
authors.initials: I
authors.lastname: Sielezneff
authors.forename: Eric
authors.initials: E
authors.lastname: Mourey
authors.forename: Philippe
authors.initials: P
authors.lastname: Ballanger
authors.forename: Francis
authors.initials: F
authors.lastname: Michot
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D015331:Cohort Studies; D003362:Cost-Benefit Analysis; D004599:Electric Stimulation Therapy / Q000191:economics* / Q000379:methods; D004567:Electrodes, Implanted; D005242:Fecal Incontinence / Q000175:diagnosis / Q000191:economics / Q000628:therapy*; D005260:Female; D005500:Follow-Up Studies; D005602:France; D017048:Health Care Costs; D006801:Humans; D008160:Lumbosacral Plexus; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D011788:Quality of Life; D018570:Risk Assessment; D018709:Statistics, Nonparametric; D016896:Treatment Outcome; D014549:Urinary Incontinence / Q000175:diagnosis / Q000191:economics / Q000628:therapy*; D055815:Young Adult