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Surgical strategies for faecal incontinence – a decision analysis between dynamic graciloplasty, artificial bowel sphincter and end stoma
Author(s) -
Tan E. K.,
Vaizey C.,
Cornish J.,
Darzi A.,
Tekkis P. P.
Publication year - 2008
Publication title -
colorectal disease
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.029
H-Index - 89
eISSN - 1463-1318
pISSN - 1462-8910
DOI - 10.1111/j.1463-1318.2007.01418.x
Subject(s) - medicine , stoma (medicine) , quality adjusted life year , quality of life (healthcare) , surgery , cost effectiveness , sphincter , cost–utility analysis , willingness to pay , risk analysis (engineering) , nursing , economics , microeconomics
Background Artificial bowel sphincter (ABS) and dynamic graciloplasty (DG) are surgical treatments for faecal incontinence (FI). FI may affect quality of life (QOL) so severely that patients are often willing to consider a permanent end stoma (ES). It is unclear which is the more cost‐effective strategy. Method Probability estimates for patients with FI were obtained from published data (ABS, n = 319; DG, n = 301), supplemented by expert opinion. The primary outcome was quality‐adjusted life years (QALYs) gained from each strategy. Factors considered were the risk of failure of the primary and redo operation and the consequent risk of permanent stoma. Results were assessed as incremental cost‐effectiveness ratio (ICER). Results Over the 5‐year time horizon, ES gave a QALY gain of 3.45 for £16 280, giving an ICER of £4719/QALY. ABS produced a gain of 4.38 QALYs for £23 569, giving an ICER of £5387/QALY. DG produced a gain of 4.00 QALYs for £25 035, giving an ICER of £6257/QALY. With the willingness‐to‐pay threshold set at £30 000/QALY, ES was the most cost‐effective intervention. The ABS was most cost‐effective after 10 years. Conclusion All three procedures were found to be cost‐effective. The ES was most cost‐effective over 5 years, while the ABS was most cost‐effective in excess of 10. DG maybe considered as an alternative in specialist centres.