Comparative Cost-Effectiveness Analysis of Sacral Anterior Root Stimulation for Rehabilitation of Bladder Dysfunction in Spinal Cord Injured Patients

BACKGROUND: Urinary disorders account for 10% of deaths in patients with complete spinal cord injury. Sacral anterior root stimulation (SARS) may be a valuable therapeutic option to restore complete and voluntary micturition (CVM), but questions on its cost-effectiveness remain. OBJECTIVE: To evaluate the cost-effectiveness of SARS to restore CVM in patients with complete spinal cord injury. METHODS: We conducted a nonrandomized, multicenter, parallel-group cohort study comparing SARS vs current medical treatments with catheterization or reflex micturition. CVM was assessed at 12 months (end of follow-up) by urodynamic examination. Medical and nonmedical costs were measured in the perspective of the French national health insurance. Linear regression models were used to estimate the incremental net benefit (INB = Delta Ex(lambda-Delta C); lambda = willingness-to-pay) adjusted for potential confounders, and P (INB > 0) (ie, probability of SARS being cost-effective vs medical treatment) for different values of lambda. RESULTS: Twenty-five patients were included in each group in 2005 to 2009. At inclusion, mean age was 41 years; 45 (90%) patients were male, and 29 (59%) patients were paraplegic. At 12 months, 15 (60%) patients with SARS had a CVM vs 3 (12%) patients with medical treatment (P < .001). The total mean cost was 42 803(sic) and 8762(sic), respectively (P < .001). After adjustment for CVM and voiding methods at inclusion, P (INB > 0) was 74% at lambda = 100 000(sic). This probability was 94% in a sensitivity analysis excluding 6 patients presenting a CVM at inclusion. CONCLUSION: The effectiveness and cost of SARS are much higher than for medical treatment. Our results inform decision makers of the opportunity to reimburse SARS in this vulnerable population.