Outcome and cost analysis of sacral nerve stimulation for faecal incontinence

Abstract

Abstract Background Sacral nerve stimulation (SNS) may be successful in treating incapacitating faecal incontinence. The technique is expensive, and no cost analysis is currently available. The aim of this study was to assess clinical outcome and analyse cost-effectiveness. Methods Thirty-six consecutive patients underwent a two-stage SNS procedure. Outcome parameters and real costs were assessed prospectively. Results SNS was tested successfully in 33 of 36 patients, and 31 patients were stimulated permanently. In the first stage, eight of 36 patients reported minor complications (pain, infection or electrode dislocation), resulting in a cost of €4053 (range €2838–7273) per patient. For the second stage (permanent stimulation), eight of 33 patients had an infection, pain or loss of effectiveness, resulting in a cost of €11 292 (range €7406–20 274) per patient. Estimated costs for further follow-up were €997 per year. The 5-year cumulative cost for SNS was €22 150 per patient, compared with €33 996 for colostomy, €31 590 for dynamic graciloplasty and €3234 for conservative treatment. Conclusion SNS is a highly cost-effective treatment for faecal incontinence. Options for further reduction of SNS costs include strict patient selection, treatment in an outpatient setting and using cheaper devices.