Annals of Surgery

Skip Navigation LinksHome > April 2011 - Volume 253 - Issue 4 > Outcome and Cost Analysis of Sacral Nerve Modulation for Tre...
Annals of Surgery:
doi: 10.1097/SLA.0b013e318210f1f4
Original Articles

Outcome and Cost Analysis of Sacral Nerve Modulation for Treating Urinary and/or Fecal Incontinence

Leroi, Anne-Marie MD, PhD*; Lenne, Xavier MSc; Dervaux, Benoît PhD; Chartier-Kastler, Emmanuel MD, PhD§; Mauroy, Brigitte MD, PhD; Normand, Loïc Le MD, PhD|; Grise, Philippe MD, PhD**; Faucheron, Jean-Luc MD, PhD††; Parc, Yann MD, PhD‡‡; Lehur, Paul-Antoine MD, PhD§§; Mion, François MD, PhD¶¶; Damon, Henri MD¶¶; Barth, Xavier MD, PhD¶¶; Leriche, Albert MD, PhD||; Saussine, Christian MD, PhD***; Guy, Laurent MD, PhD†††; Haab, François MD, PhD‡‡‡; Bresler, Laurent MD, PhD§§§; Sarramon, Jean-Pierre MD, PhD¶¶¶; Bensadoun, Henri MD, PhD|||; Rullier, Eric MD, PhD****; Slim, Karem MD, PhD††††; Sielezneff, Igor MD, PhD‡‡‡‡; Mourey, Eric MD§§§§; Ballanger, Philippe MD, PhD¶¶¶¶; Michot, Francis MD, PhD*

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Background: Sacral nerve modulation (SNM) is an established treatment for urinary and fecal incontinence in patients for whom conservative management has failed.

Objective: This study assessed the outcome and cost analysis of SNM compared to alternative medical and surgical treatments.

Methods: Clinical outcome and cost-effectiveness analyses were performed in parallel with a prospective, multicenter cohort study that included 369 consecutive patients with urge urinary and/or fecal incontinence. The duration of follow-up was 24 months, and costs were estimated from the national health perspective. Cost-effectiveness outcomes were expressed as incremental costs per 50% of improved severity scores (incremental cost-effectiveness ratio).

Results: The SNM significantly improved the continence status (P < 0.005) and quality of life (P < 0.05) of patients with urge urinary and/or fecal incontinence compared to alternative treatments. The average cost of SNM for urge urinary incontinence was € 8525 (95% confidence interval, € 6686–€ 10,364; P = 0.001) more for the first 2 years compared to alternative treatments. The corresponding increase in cost for subjects with fecal incontinence was € 6581 (95% confidence interval, € 2077–€ 11,084; P = 0.006). When an improvement of more than 50% in the continence severity score was used as the unit of effectiveness, the incremental cost-effectiveness ratio for SNM was € 94,204 and € 185,160 at 24 months of follow-up for urinary and fecal incontinence, respectively.

Conclusions: The SNM is a cost-effective treatment for urge urinary and/or fecal incontinence.

© 2011 Lippincott Williams & Wilkins, Inc.


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