Cost-effectiveness of sacral neuromodulation for chronic refractory constipation in children.


eMediNexus    13 February 2018

A recent study published in Colorectal Disease assessed the cost-effectiveness of sacral neuromodulation (SNM) relative to conservative treatment in children and adolescents with constipation refractory to conservative management. This study included children and adolescents aged 10-18 years with constipation refractory to conservative management, wherein a Markov probabilistic model was utilized to compare costs and effectiveness of SNM and conservative treatment. This cohort consisted of 30 female patients, with a mean age of 16 years, having functional constipation refractory to conservative management. The mean duration of laxative use in this group was 5.9 years, all patients underwent a test SNM. In 27 of these patients, a subsequent permanent SNM was performed. The results showed that: the mean cumulative costs for the SNM group and the conservative treatment group were €17 789 and €7574 per patient, respectively. While the mean quality adjusted life years (QALYs) in the SNM group was 1.74, compared to 0.86 in the conservatively managed group. Additionally, the mean incremental cost-effectiveness ratio was €12 328 per QALY. Furthermore, sensitivity analysis exhibited that the outcomes were robust to a wide range of model assumptions. Hence, it was concluded that chronic constipation seriously affects the quality of life of children and adolescents; meanwhile, SNM can improve symptoms and quality of life at a reasonable cost.

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