Long-Term Cost-Effectiveness of Transanal Irrigation in Patients with Neurogenic Bowel Dysfunction

PLoS ONE, 2016 · DOI: 10.1371/journal.pone.0159394 · Published: August 24, 2016

Simple Explanation

This study looked at whether using transanal irrigation (TAI) is a cost-effective way to manage bowel problems in people with neurogenic bowel dysfunction (NBD). NBD can happen due to conditions like spinal cord injury or multiple sclerosis. The researchers used a computer model to predict what would happen over a person's lifetime if they used TAI compared to standard bowel care (SBC). The model looked at things like quality of life, how often people had accidents, and whether they needed surgery. The results showed that TAI could save money and improve quality of life for people with NBD compared to SBC. It also reduced the number of accidents, urinary tract infections, and surgeries needed.

Study Duration

30 years

Participants

227 patients with NBD due to spinal cord injury (SCI), multiple sclerosis, spina bifida and cauda equina syndrome

Evidence Level

Not specified

Key Findings

1
The model predicts that a 30-year old SCI patient with a life expectancy of 37 years initiating TAI will experience a 36% reduction in FI episodes.
2
A lifetime cost-saving of £21,768 per patient was estimated for TAI versus continuing SBC alone.
3
The model also predicted a 35% reduction in the frequency of stoma surgery associated with the use of TAI.

Research Summary

The study investigated the long-term cost-effectiveness of transanal irrigation (TAI) in patients with neurogenic bowel dysfunction (NBD) who have failed standard bowel care (SBC). A deterministic Markov model projected lifetime health economic outcomes, including quality-adjusted life years (QALYs), episodes of fecal incontinence (FI), urinary tract infections (UTIs), and stoma surgery. The model estimated a lifetime total cost-savings of £21,768 per patient using TAI compared with SBC, with TAI being a dominant strategy offering increased benefits at lower costs.

Practical Implications

Clinical Practice

TAI should be implemented as standard treatment for patients with NBD who have failed standard bowel care (SBC).

Health Economics

TAI is a cost-saving treatment strategy, reducing the risk of stoma surgery, UTIs, and episodes of fecal incontinence while improving QALYs.

Future Research

Further research is warranted to investigate the impact of TAI on HRQoL using different outcome measures.

Study Limitations

1
The EQ-5D may be too generic to measure improved quality of life related to bowel management for the NBD population.
2
Transferability of the model to a setting outside of the UK would require that the analysis consider clinical practice variations.
3
The frequency of UTI was based on self-reported number of treatment required UTIs, which introduces a risk of recall bias.

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