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Outcome and Cost Analysis of Sacral Nerve Modulation for Treating Urinary and/or Fecal Incontinence.
MedLine Citation:
PMID:  21475012     Owner:  NLM     Status:  Publisher    
Abstract/OtherAbstract:
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 &OV0556; 8525 (95% confidence interval, &OV0556; 6686-&OV0556; 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 &OV0556; 6581 (95% confidence interval, &OV0556; 2077-&OV0556; 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 &OV0556; 94,204 and &OV0556; 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.
Authors:
Anne-Marie Leroi; Xavier Lenne; Benoît Dervaux; Emmanuel Chartier-Kastler; Brigitte Mauroy; Loïc Le Normand; Philippe Grise; Jean-Luc Faucheron; Yann Parc; Paul-Antoine Lehur; François Mion; Henri Damon; Xavier Barth; Albert Leriche; Christian Saussine; Laurent Guy; François Haab; Laurent Bresler; Jean-Pierre Sarramon; Henri Bensadoun; Eric Rullier; Karem Slim; Igor Sielezneff; Eric Mourey; Philippe Ballanger; Francis Michot
Publication Detail:
Type:  JOURNAL ARTICLE    
Journal Detail:
Title:  Annals of surgery     Volume:  253     ISSN:  1528-1140     ISO Abbreviation:  -     Publication Date:  2011 Apr 
Date Detail:
Created Date:  2011-4-8     Completed Date:  -     Revised Date:  -    
Medline Journal Info:
Nlm Unique ID:  0372354     Medline TA:  Ann Surg     Country:  -    
Other Details:
Languages:  ENG     Pagination:  720-732     Citation Subset:  -    
Affiliation:
*ADEN EA 3234/IFR MP 23, Rouen University Hospital, Rouen, France. †CRESGE-LEM (CNRS URA No. 362), Catholic University of Lille, Secteur PMSI, Lille University Hospital, Lille, France. ‡Université "Droit et Santé"-Lille 2, Faculty of Medicine, DRCI-Lille University Hospital, Lille, France. §Urology Department, Pierre et Marie Curie Medical School, Paris VI, Paris, France. ¶Urology Department, Lille University Hospital GHICL, Lille, France. |Urology Department, Nantes University Hospital, Nantes. **Urology Department, Rouen University Hospital, Rouen, France. ††Digestive Surgery Department, Grenoble University Hospital, Grenoble, France. ‡‡Digestive Surgery Department, Saint-Antoine Hospital, Paris, France. §§Digestive Surgery Department, Nantes University Hospital, Nantes, France. ¶¶Digestive Physiology Department, Edouard Herriot Hospital, Lyon, France. ||Urology Department, Henry Gabrielle Hospital, University of Lyon I, Lyon, France. ***Urology Department, Strasbourg University Hospital, Strasbourg, France. †††Urology Department, Montpied Hospital, Clermont-Ferrand University, Clermont-Ferrand, France. ‡‡‡Urology Department, Tenon Hospital, Paris, France. §§§Digestive Surgery Department, Nancy University Hospital, Nancy, France. ¶¶¶Urology Department, Rangueil Hospital, Toulouse, France. |||Urology Department, Caen University Hospital, Caen, France. ****Digestive Surgery Department, Bordeaux University Hospital, Bordeaux, France. ††††Digestive Surgery Department, Clermont-Ferrand University Hospital, Clermont-Ferrand, France. ‡‡‡‡Digestive Surgery Department, Sainte Marguerite Hospital, Marseille, France. §§§§Urology Department, Le Bocage Hospital, Dijon, France. ¶¶¶¶Urology Department, Pellegrin Hospital, Bordeaux, France.
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