Department of Surgery, Maastricht University Medical Center, Maastricht, the Netherlands.
Department of Health Evidence, Radboud University Medical Center, Nijmegen, the Netherlands.
Colorectal Dis. 2017 Nov;19(11):1013-1023. doi: 10.1111/codi.13869.
This 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.
A Markov probabilistic model was used, comparing costs and effectiveness of SNM and conservative treatment in children and adolescents aged 10-18 years 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 16 years) with functional constipation refractory to conservative management. The mean duration of laxative use in this group was 5.9 years. All patients had a test SNM, followed by a permanent SNM in 27/30. Median follow-up was 22.1 months (range 12.2-36.8). The model was run to simulate a follow-up period of 3 years.
The mean cumulative costs for the SNM group and the conservative treatment group were €17 789 (SD €2492) and €7574 (SD €4332) 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 €12 328 per QALY (SD €4788). Sensitivity analysis showed that the outcomes were robust to a wide range of model assumptions.
Chronic 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.
本研究旨在评估骶神经调节（SNM）与保守治疗相比在保守治疗无效的儿童和青少年便秘中的成本效益。
采用马尔可夫概率模型，比较了保守治疗和 SNM 在保守治疗无效的 10-18 岁儿童和青少年便秘中的成本和效果。模型中关于转移概率、效用和医疗保健成本的输入数据基于我们中心治疗的患者队列数据。该队列包括 30 名（平均年龄 16 岁）功能性便秘且保守治疗无效的女性患者。该组患者使用泻药的平均持续时间为 5.9 年。所有患者均接受了测试性 SNM，随后 27/30 名患者接受了永久性 SNM。中位随访时间为 22.1 个月（范围 12.2-36.8）。模型运行模拟了 3 年的随访期。
SNM 组和保守治疗组的平均累积成本分别为每位患者 17789 欧元（标准差 2492 欧元）和 7574 欧元（标准差 4332 欧元）。SNM 组的平均质量调整生命年（QALY）为 1.74（标准差 0.19），而保守治疗组为 0.86（标准差 0.14）。平均增量成本效益比为每 QALY 12328 欧元（标准差 4788 欧元）。敏感性分析表明，结果对模型假设的广泛范围具有稳健性。
慢性便秘严重影响儿童和青少年的生活质量。初步证据表明，SNM 可以以合理的成本改善症状和生活质量。
