Long-Term Cost-Effectiveness of Transanal Irrigation In Patients With Neurogenic Bowel Dysfunction Who Have Failed Standard Bowel Care.

To investigate the long-term cost-effectiveness of initiating transanal irrigation* (TAI) as second-line management in patients with neurogenic bowel dysfunction (NBD) who have failed first-line standard bowel care (SBC). A deterministic Markov decision model was developed to project the lifetime health economic outcomes, including quality-adjusted life expectancy (QALE), episodes of faecal incontinence (FI), urinary tract infections (UTIs), and stoma surgery when using TAI relative to continuing SBC. Patients could transition from TAI to (a) another round of first-line SBC, (b) third-line surgeries (sacral nerve stimulator, sacral anterior root stimulator, antegrade continence enema) or (c) stoma as the absorbing state. Transition probabilities and QALE estimates were based on real-world data collected at three clinics in UK from 2007-2014, in NBD patients due to spinal cord injury (SCI), multiple sclerosis, spina bifida, and cauda equina syndrome. Transition probabilities for failed SBC patients were collected from 2000-2007 prior to availability of TAI. Projected life-expectancy was based on published SCI population data. One-way sensitivity analyses were applied. The model predicts that a SCI patient diagnosed aged 30, with a life expectancy of 37 years using TAI, will experience a 36.1% reduction in FI, 28.7% reduction in UTIs, a 35.4% reduction in stoma surgery and improvement of 0.40 years of QALE, compared with patients continuing SBC. Lifetime cost-savings of £41,620 per patient was estimated for TAI versus SBC in a SCI patient, primarily due to avoided hospitalizations and stoma surgeries. Incremental cost can differ due to altered life-expectancy (and age of diagnosis) in the patient cohort. One-way sensitivity analyses indicated that the model was most sensitive to variation in utilities on TAI and SBC treatment. TAI is a cost-saving treatment strategy reducing risk of stoma surgery and improving QALE for NBD patients who have failed SBC. *Peristeen (Coloplast A/S).