Cost-effectiveness of sacral neuromodulation for chronic refractory constipation in children and adolescents: a Markov model analysis

AimThis study aimed to assess the cost-effectiveness of sacral neuromodulation (SNM) compared with conservative treatment in children and adolescents with constipation refractory to conservative management. MethodA Markov probabilistic model was used, comparing costs and effectiveness of SNM and conservative treatment in children and adolescents aged 10-18years with constipation refractory to conservative management. Input for the model regarding transition probabilities, utilities and healthcare costs was based on data from a cohort of patients treated in our centre. This cohort consisted of 30 female patients (mean age 16years) with functional constipation refractory to conservative management. The mean duration of laxative use in this group was 5.9years. All patients had a test SNM, followed by a permanent SNM in 27/30. Median follow-up was 22.1months (range 12.2-36.8). The model was run to simulate a follow-up period of 3years. ResultsThe mean cumulative costs for the SNM group and the conservative treatment group were Euro17789 (SD Euro2492) and Euro7574 (SD Euro4332) per patient, respectively. The mean quality adjusted life years (QALYs) in the SNM group was 1.74 (SD 0.19), compared with 0.86 (SD 0.14) in the conservatively managed group. The mean incremental cost-effectiveness ratio was Euro12328 per QALY (SD Euro4788). Sensitivity analysis showed that the outcomes were robust to a wide range of model assumptions. ConclusionChronic constipation seriously affects the quality of life of children and adolescents. Preliminary evidence suggests that SNM can improve symptoms and quality of life at a reasonable cost.