Cost-Effectiveness Analysis of Transanal Irrigation for Managing Neurogenic Bowel Dysfunction in Japan

JHEOR, 2018 · DOI: 10.36469/9781 · Published: January 1, 2018

Simple Explanation

This study examines whether using transanal irrigation (TAI) is a cost-effective way to manage bowel problems caused by nerve damage in Japanese patients with spinal cord injury (SCI). TAI involves putting water into the rectum to help remove feces and prevent issues like incontinence and constipation. The researchers compared the costs and quality of life improvements for SCI patients using TAI versus those using standard bowel care (SBC). They used a computer model to predict the long-term outcomes of both approaches, focusing on factors like healthcare costs and patient well-being. The study found that TAI is likely a cost-effective treatment in Japan, as the extra costs are reasonable compared to the benefits in quality of life for patients. This suggests that TAI could be a valuable option for managing bowel dysfunction in SCI patients in Japan.

Study Duration

Lifetime time horizon

Participants

217 SCI patients meeting specific criteria

Evidence Level

Markov model analysis

Key Findings

1
The model predicts a lifetime incremental cost of TAI to be 3 198 687 yen compared with SBC.
2
TAI provided an additional 0.8 QALY, which leads to an incremental cost-effectiveness ratio (ICER) of TAI vs SBC of 4 016 287 yen/QALY.
3
An ICER of 4 million yen falls within the range of reported willingness to pay (WTP) per QALY gain (5–6.7 million yen) in Japan, and TAI is therefore found to be a cost-effective treatment strategy compared to SBC.

Research Summary

This study evaluated the cost-effectiveness of transanal irrigation (TAI) compared to standard bowel care (SBC) for managing neurogenic bowel dysfunction (NBD) in Japanese patients with spinal cord injury (SCI). A modified Markov model was used to assess the incremental cost-effectiveness ratio (ICER) from the payer’s perspective, with quality-adjusted life years (QALYs) as the primary outcome measure. The results indicated that TAI is a cost-effective treatment strategy compared to SBC in Japan, with an ICER of 4 016 287 yen/QALY. This value falls within the reported willingness to pay per QALY gain in Japan. Sensitivity analyses showed that the utility weight for patients responding to TAI treatment had the largest impact on the analysis outcome. Scenario analysis including productivity loss due to absenteeism and presenteeism further supported the cost-effectiveness of TAI.

Practical Implications

Healthcare Policy

The findings support the consideration of TAI as a reimbursed treatment option for NBD in SCI patients within the Japanese healthcare system.

Clinical Practice

Clinicians can use this information to inform discussions with patients about the potential benefits and costs of TAI compared to SBC.

Further Research

Future studies should focus on collecting Japanese-specific data on utility values and long-term outcomes to refine the cost-effectiveness model and validate the current findings.

Study Limitations

1
The expected utility weight corresponding to each NBDS was estimated and used in the model.
2
The stoma creation rates have been calculated by regression analysis of the patient survey results and not on actual trial data.
3
The general evidence base for the impact of TAI requires further investigation on the effectiveness of TAI based on solid clinical trials

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