title: Long-Term Cost-Effectiveness of Transanal Irrigation in Patients with Neurogenic Bowel Dysfunction.
abstract: BACKGROUND
  People suffering from neurogenic bowel dysfunction (NBD) and an ineffective bowel regimen often suffer from fecal incontinence (FI) and related symptoms, which have a huge impact on their quality of life. In these situations, transanal irrigation (TAI) has been shown to reduce these symptoms and improve quality of life.
  
  
  OBJECTIVE
  To investigate the long-term cost-effectiveness of initiating TAI in patients with NBD who have failed standard bowel care (SBC).
  
  
  METHODS
  A deterministic Markov decision model was developed to project the lifetime health economic outcomes, including quality-adjusted life years (QALYs), episodes of FI, urinary tract infections (UTIs), and stoma surgery when initiating TAI relative to continuing SBC. A data set consisting of 227 patients with NBD due to spinal cord injury (SCI), multiple sclerosis, spina bifida and cauda equina syndrome was used in the analysis. In the model a 30-year old individual with SCI was used as a base-case. A probabilistic sensitivity analysis was applied to evaluate the robustness of the model.
  
  
  RESULTS
  The model predicts that a 30-year old SCI patient with a life expectancy of 37 years initiating TAI will experience a 36% reduction in FI episodes, a 29% reduction in UTIs, a 35% reduction in likelihood of stoma surgery and a 0.4 improvement in QALYs, compared with patients continuing SBC. A lifetime cost-saving of £21,768 per patient was estimated for TAI versus continuing SBC alone.
  
  
  CONCLUSIONS
  TAI is a cost-saving treatment strategy reducing risk of stoma surgery, UTIs, episodes of FI and improving QALYs for NBD patients who have failed SBC.
authors.affiliation: GI Physiology Unit, University College London Hospital, London, United Kingdom.
authors.forename: Anton
authors.initials: A
authors.lastname: Emmanuel
authors.affiliation: ICON Health Economics, Oxford, United Kingdom.
authors.forename: Gayathri
authors.initials: G
authors.lastname: Kumar
authors.affiliation: Pelvic Floor Unit, Aarhus University Hospital, Aarhus, Denmark.
authors.forename: Peter
authors.initials: P
authors.lastname: Christensen
authors.affiliation: ICON Health Economics, Oxford, United Kingdom.
authors.forename: Stuart
authors.initials: S
authors.lastname: Mealing
authors.affiliation: Coloplast A/S, Humlebaek, Denmark.
authors.forename: Zenia M
authors.initials: ZM
authors.lastname: Størling
authors.affiliation: Coloplast A/S, Humlebaek, Denmark.
authors.forename: Frederikke
authors.initials: F
authors.lastname: Andersen
authors.affiliation: Kessler Institute for Rehabilitation, Rutgers New Jersey Medical School, Newark, New Jersey, United States of America.
authors.forename: Steven
authors.initials: S
authors.lastname: Kirshblum
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D001003:Anal Canal / Q000503:physiopathology; D003362:Cost-Benefit Analysis; D005242:Fecal Incontinence; D005260:Female; D006801:Humans; D008297:Male; D008390:Markov Chains; D008875:Middle Aged; D055496:Neurogenic Bowel / Q000503:physiopathology / Q000628:therapy*; D011788:Quality of Life; D019057:Quality-Adjusted Life Years; D007507:Therapeutic Irrigation / Q000191:economics / Q000379:methods; D055815:Young Adult