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.

Aim: 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.

Conclusion: 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.

Conflict of interest statement

FA and ZS are employees of Coloplast A/S who have funded the study. AE, PC and SK are occasionally used as KOLs for advisory boards at Coloplast A/S. The authors confirm that this does not alter the authors' adherence to PLOS ONE policies on sharing data and materials.

Figures

Fig 1. Data and Markov model overview.

The boxes represent the health states that a neurogenic patient can transition between after having failed standard bowel care (SBC) before and after 2007. SBC alone. After having failed SBC >6 months, a patient can either a) Resume SBC, b) Progress to SNS/SARS/ACE or d) Progress to stoma (absorbing state). TAI in combination with SBC. After having failed SBC >6 months, a patient can either a) Initiate Peristeen TAI, b) Resume SBC, c) Progress to SNS/SARS/ACE or d) Progress to stoma. The model assumes that patients do not transition directly from SBC/TAI to stoma. Transition probabilities have been obtained for each 6-month model cycle using GoalSeek in Excel.

Fig 2. Tornado diagram.

Fig 3. Cost-effectiveness plane.

WTP: Willingness to pay: linear threshold corresponds to the WTP value used by NICE in making reimbursement decisions (£30.000 per QALY gained). Each quadrant corresponds to one incremental cost option (cost saving, not cost saving) and one incremental benefit option (more/less benefit than comparator therapy).