RESUMEN
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.
Asunto(s)
Terapia por Estimulación Eléctrica/economía , Incontinencia Fecal/terapia , Costos de la Atención en Salud , Plexo Lumbosacro , Incontinencia Urinaria/terapia , Adulto , Anciano , Anciano de 80 o más Años , Estudios de Cohortes , Análisis Costo-Beneficio , Terapia por Estimulación Eléctrica/métodos , Electrodos Implantados , Incontinencia Fecal/diagnóstico , Incontinencia Fecal/economía , Femenino , Estudios de Seguimiento , Francia , Humanos , Masculino , Persona de Mediana Edad , Estudios Prospectivos , Calidad de Vida , Medición de Riesgo , Estadísticas no Paramétricas , Resultado del Tratamiento , Incontinencia Urinaria/diagnóstico , Incontinencia Urinaria/economía , Adulto JovenRESUMEN
The authors report two cases of patients presenting with complex voiding disorders treated successfully by bilateral neuromodulation. In the first patient, bilateral neuromodulation (left S2 and right S3) was indicated after failure of a first trial of conventional neuromodulation. In the second case, a complementary electrode in addition to the S3 electrode was placed at S1 to treat nerve root pain associated with urinary symptoms. The preoperative and postoperative findings are reported together with the course and possible explanations for the success of this treatment modality.