Economic evaluation of sacral nerve stimulation for faecal incontinence

Abstract

Abstract Background Sacral nerve stimulation (SNS) is an established treatment for faecal incontinence in patients who have failed conservative management. This study established the cost-effectiveness of treating patients with SNS compared with non-surgical treatment. Methods A decision analysis model was performed. Data from 70 patients were obtained from medical records, bowel habit diaries and Short Form 36 quality of life questionnaires. Direct medical and non-medical costs were ascertained using the 2005/2006 national tariff, national statistics, and medication, pad and device costs. Indirect non-medical costs were also estimated. Results Incontinence episodes were reduced from a median of 12 per fortnight at baseline to one per fortnight with SNS. Based on direct medical and non-medical costs, the incremental cost-effectiveness ratio (ICER) for SNS was £25 070 per QALY gained. It cost £1038 more per year to treat patients with SNS for a median reduction of 286 incontinence episodes, equating to £3·63 per episode reduced. When indirect non-medical costs were included the ICER was reduced to £12 959 per QALY gained. Conclusion The ICER of £25 070 is within the £30 000 per QALY threshold recommended by the National Institute for Health and Clinical Excellence as an effective use of National Health Service resources with proper justification.