Hetzer F H, Bieler A, Hahnloser D, Löhlein F, Clavien P-A, Demartines N
Division of Visceral and Transplantation Surgery, University Hospital of Zurich, Ramistrasse 100, CH 8091 Zurich, Switzerland.
Br J Surg. 2006 Nov;93(11):1411-7. doi: 10.1002/bjs.5491.
Sacral nerve stimulation (SNS) may be successful in treating incapacitating faecal incontinence. The technique is expensive, and no cost analysis is currently available. The aim of this study was to assess clinical outcome and analyse cost-effectiveness.
Thirty-six consecutive patients underwent a two-stage SNS procedure. Outcome parameters and real costs were assessed prospectively.
SNS was tested successfully in 33 of 36 patients, and 31 patients were stimulated permanently. In the first stage, eight of 36 patients reported minor complications (pain, infection or electrode dislocation), resulting in a cost of euro 4053 (range euro 2838-7273) per patient. For the second stage (permanent stimulation), eight of 33 patients had an infection, pain or loss of effectiveness, resulting in a cost of euro 11,292 (range euro 7406-20,274) per patient. Estimated costs for further follow-up were euro 997 per year. The 5-year cumulative cost for SNS was euro 22,150 per patient, compared with euro 33,996 for colostomy, euro 31,590 for dynamic graciloplasty and euro 3234 for conservative treatment.
SNS is a highly cost-effective treatment for faecal incontinence. Options for further reduction of SNS costs include strict patient selection, treatment in an outpatient setting and using cheaper devices.
骶神经刺激（SNS）可能成功治疗严重的大便失禁。该技术成本高昂，目前尚无成本分析。本研究的目的是评估临床疗效并分析成本效益。
连续36例患者接受了两阶段的SNS手术。前瞻性评估结果参数和实际成本。
36例患者中有33例SNS测试成功，31例患者接受了永久性刺激。在第一阶段，36例患者中有8例报告了轻微并发症（疼痛、感染或电极移位），每位患者的成本为4053欧元（范围为2838 - 7273欧元）。对于第二阶段（永久性刺激），33例患者中有8例出现感染、疼痛或效果丧失，每位患者的成本为11292欧元（范围为7406 - 20274欧元）。进一步随访的估计成本为每年997欧元。SNS的5年累计成本为每位患者每年22150欧元，相比之下，结肠造口术为33996欧元，动态股薄肌成形术为31590欧元，保守治疗为3234欧元。
SNS是一种治疗大便失禁性价比很高的方法。进一步降低SNS成本的选择包括严格的患者选择、门诊治疗以及使用更便宜的设备。
