Clinical and cost effectiveness of sacral nerve stimulation for faecal incontinence

2008 ◽  
Vol 95 (8) ◽  
pp. 1037-1043 ◽  
Author(s):  
A. Muñoz‐Duyos ◽  
A. Navarro‐Luna ◽  
M. Brosa ◽  
J. A. Pando ◽  
A. Sitges‐Serra ◽  
...  
Keyword(s):  
Cost Effectiveness ◽  
Faecal Incontinence ◽  
Nerve Stimulation ◽  
Sacral Nerve Stimulation ◽  
Sacral Nerve

scholarly journals Cost-effectiveness of sacral nerve stimulation and percutaneous tibial nerve stimulation for faecal incontinence

2018 ◽  
Vol 11 ◽  
pp. 175628481880256 ◽  
Author(s):  
Natalia Hounsome ◽  
Chris Roukas
Keyword(s):  
Cost Effectiveness ◽  
Faecal Incontinence ◽  
Nerve Stimulation ◽  
Sacral Nerve Stimulation ◽  
Tibial Nerve ◽  
Cost Effective ◽  
Decision Analytic Model ◽  
Percutaneous Tibial Nerve Stimulation ◽  
Sacral Nerve ◽  
Tibial Nerve Stimulation

Background: Subcutaneous sacral nerve stimulation is recommended by the United Kingdom (UK) National Institute for Health and Care Excellence (NICE) as a second-line treatment for patients with faecal incontinence who failed conservative therapy. Sacral nerve stimulation is an invasive procedure associated with complications and reoperations. This study aimed to investigate whether delivering less invasive and less costly percutaneous tibial nerve stimulation prior to sacral nerve stimulation is cost-effective. Methods: A decision analytic model was developed to estimate the cost-effectiveness of percutaneous tibial nerve stimulation with subsequent subcutaneous sacral nerve stimulation versus subcutaneous sacral nerve stimulation alone. The model was populated with effectiveness data from systematic reviews and cost data from randomized studies comparing both procedures in a UK National Health Service (NHS) setting. Results: Offering percutaneous tibial nerve stimulation prior to sacral nerve stimulation (compared with delivering sacral nerve stimulation straight away) was both more effective and less costly in all modeled scenarios. The estimated savings from offering percutaneous tibial nerve stimulation first were £662–£5,697 per patient. The probability of this strategy being cost-effective was around 80% at £20,000–£30,000 per quality-adjusted life-year (QALY). Conclusion: Our analyses suggest that offering patients percutaneous tibial nerve stimulation prior to sacral nerve stimulation can be both cost-effective and cost-saving in the treatment of faecal incontinence.

scholarly journals Sacral nerve stimulation versus the magnetic sphincter augmentation device for adult faecal incontinence: the SaFaRI RCT

2021 ◽  
Vol 25 (18) ◽  
pp. 1-96
Author(s):  
David G Jayne ◽  
Annabelle E Williams ◽  
Neil Corrigan ◽  
Julie Croft ◽  
Alison Pullan ◽  
...  
Keyword(s):  
Cost Effectiveness ◽  
Faecal Incontinence ◽  
Nerve Stimulation ◽  
Sacral Nerve Stimulation ◽  
Quality Adjusted Life Years ◽  
Treatment Pathways ◽  
Sacral Nerve ◽  
Life Years ◽  
Quality Adjusted Life

Background Preliminary studies using the FENIX™ (Torax Medical, Minneapolis, MN, USA) magnetic sphincter augmentation device suggest that it is safe to use for the treatment of adult faecal incontinence, but efficacy data are limited. Objective To compare FENIX with sacral nerve stimulation for the treatment of adult faecal incontinence in terms of safety, efficacy, quality of life and cost-effectiveness. Design, setting and participants Multicentre, parallel-group, unblinded, randomised trial comparing FENIX with sacral nerve stimulation in participants suffering moderate to severe faecal incontinence. Interventions Participants were randomised on an equal basis to either sacral nerve stimulation or FENIX. Follow-up occurred 2 weeks postoperatively and at 6, 12 and 18 months post randomisation. Main outcome and measure The primary outcome was success, defined as device in use and ≥ 50% improvement in Cleveland Clinic Incontinence Score at 18 months post randomisation. Secondary outcomes included complication rates, quality of life and cost-effectiveness. Between 30 October 2014 and 23 March 2017, 99 participants were randomised across 18 NHS sites (50 participants to FENIX vs. 49 participants to sacral nerve stimulation). The median time from randomisation to FENIX implantation was 57.0 days (range 4.0–416.0 days), and the median time from randomisation to permanent sacral nerve stimulation was 371.0 days (range 86.0–918.0 days). A total of 45 out of 50 participants underwent FENIX implantation and 29 out of 49 participants continued to permanent sacral nerve stimulation. The following results are reported, excluding participants for whom the corresponding outcome was not evaluable. Overall, there was success for 10 out of 80 (12.5%) participants, with no statistically significant difference between the two groups [FENIX 6/41 (14.6%) participants vs. sacral nerve stimulation 4/39 (10.3%) participants]. At least one postoperative complication was experienced by 33 out of 45 (73.3%) participants in the FENIX group and 9 out of 40 (22.5%) participants in the sacral nerve stimulation group. A total of 15 out of 50 (30%) participants in the FENIX group ultimately had to have their device explanted. Slightly higher costs and quality-adjusted life-years (incremental = £305.50 and 0.005, respectively) were observed in the FENIX group than in the sacral nerve stimulation group. This was reversed over the lifetime horizon (incremental = –£1306 and –0.23 for costs and quality-adjusted life-years, respectively), when sacral nerve stimulation was the optimal option (net monetary benefit = –£3283), with only a 45% chance of FENIX being cost-effective. Limitations The SaFaRI study was terminated in 2017, having recruited 99 participants of the target sample size of 350 participants. The study is, therefore, substantially underpowered to detect differences between the treatment groups, with significant uncertainty in the cost-effectiveness analysis. Conclusions The SaFaRI study revealed inefficiencies in the treatment pathways for faecal incontinence, particularly for sacral nerve stimulation. The success of both FENIX and sacral nerve stimulation was much lower than previously reported, with high postoperative morbidity in the FENIX group. Future work Further research is needed to clarify the treatment pathways for sacral nerve stimulation and to determine its true clinical and cost-effectiveness. Trial registration Current Controlled Trials ISRCTN16077538. Funding This project was funded by the National Institute for Health Research (NIHR) Health Technology Assessment programme and will be published in full in Health Technology Assessment; Vol. 25, No. 18. See the NIHR Journals Library website for further project information.

scholarly journals PTH-024 A Multicentre Experience of Sacral Nerve Stimulation (SNS) In Scleroderma Faecal Incontinence: Abstract PTH-024 Table 1

Gut ◽  
2013 ◽  
Vol 62 (Suppl 1) ◽  
pp. A221.1-A221
Author(s):  
S K Butt ◽  
A Alam ◽  
K Krogh ◽  
S Buntzen ◽  
A Emmanuel
Keyword(s):  
Faecal Incontinence ◽  
Nerve Stimulation ◽  
Sacral Nerve Stimulation ◽  
Sacral Nerve

Sacral nerve stimulation reduces corticoanal excitability in patients with faecal incontinence

2005 ◽  
Vol 92 (11) ◽  
pp. 1423-1431 ◽  
Author(s):  
R. Sheldon ◽  
E. S. Kiff ◽  
A. Clarke ◽  
M. L. Harris ◽  
S. Hamdy
Keyword(s):  
Faecal Incontinence ◽  
Nerve Stimulation ◽  
Sacral Nerve Stimulation ◽  
Sacral Nerve

scholarly journals Sacral nerve stimulation for faecal incontinence and constipation in adults

2015 ◽  
Author(s):  
Mohamed A Thaha ◽  
Amin A Abukar ◽  
Noel N Thin ◽  
Anthony Ramsanahie ◽  
Charles H Knowles
Keyword(s):  
Faecal Incontinence ◽  
Nerve Stimulation ◽  
Sacral Nerve Stimulation ◽  
Sacral Nerve

Bilateral compared with unilateral sacral nerve stimulation for faecal incontinence: results of a randomized, single-blinded crossover study

2015 ◽  
Vol 17 (12) ◽  
pp. 1085-1093 ◽  
Author(s):  
J. Duelund-Jakobsen ◽  
S. Buntzen ◽  
L. Lundby ◽  
M. Sørensen ◽  
S. Laurberg
Keyword(s):  
Crossover Study ◽  
Faecal Incontinence ◽  
Nerve Stimulation ◽  
Sacral Nerve Stimulation ◽  
Sacral Nerve
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