ClinicSpeak: anal irrigation is cost-effective

Are you suffering from intractable constipation and faecal incontinence? #ClinicSpeak #MSResearch 

“I forgot my rose-tinted spectacles at home. Some of you don’t like the messy side of MS-related disability and if you are one of those please look away now.”

“The paper below looks at the cost-effectiveness of transanal irrigation in patients with neurogenic bowel dysfunction. It comes as no surprise that transanal irrigation is a cost-saving treatment strategy reducing risk of stoma surgery, UTIs, episodes of  faecal incontinence and improving quality of life in patients who have failed standard bowel care. It is important to realise that to remain independent MSers need to maintain upper limb and hand function. This is particularly important if you want to manage the anal irrigation system yourself. Anal irrigation is another reason to support our #ThinkHand campaign.”

“I have posted many times in the past on constipation and bowel dysfunction, so many of you may find this, and other posts like it, repetitive. If you do have bowel problems and are not coping please contact your MS team for help; there is a lot we can do.”

Multiple Sclerosis Research: ClinicSpeak: constipation and MS…/…

Mar 16, 2016 – The cause is multifactorial and related to many factors; poor diet, medication, lack of exercise, dehydration and slow bowel movements due to …

Multiple Sclerosis Research: ClinicSpeak: rectal dysfunction

Sep 8, 2014 – #ClinicSpeak #MSBlog #MSResearch “This weekend was … “This abstract highlights the problem of bowel dysfunction that is common in MS.

Emmanuel et al. Long-Term Cost-Effectiveness of Transanal Irrigation in Patients with Neurogenic Bowel Dysfunction. PLoS One. 2016 Aug 24;11(8):e0159394. doi: 10.1371/journal.pone.0159394. eCollection 2016.

BACKGROUND: People suffering from neurogenic bowel dysfunction (NBD) and an ineffective bowel regimen often suffer from fecal incontinence (FI) and related symptoms, which have a huge impact on their quality of life. In these situations, transanal irrigation (TAI) has been shown to reduce these symptoms and improve quality of life.

AIM: To investigate the long-term cost-effectiveness of initiating TAI in patients with NBD who have failed standard bowel care (SBC).

METHODS: A deterministic Markov decision model was developed to project the lifetime health economic outcomes, including quality-adjusted life years (QALYs), episodes of FI, urinary tract infections (UTIs), and stoma surgery when initiating TAI relative to continuing SBC. A data set consisting of 227 patients with NBD due to spinal cord injury (SCI), multiple sclerosis, spina bifida and cauda equina syndrome was used in the analysis. In the model a 30-year old individual with SCI was used as a base-case. A probabilistic sensitivity analysis was applied to evaluate the robustness of the model.

RESULTS: The model predicts that a 30-year old SCI patient with a life expectancy of 37 years initiating TAI will experience a 36% reduction in FI episodes, a 29% reduction in UTIs, a 35% reduction in likelihood of stoma surgery and a 0.4 improvement in QALYs, compared with patients continuing SBC. A lifetime cost-saving of £21,768 per patient was estimated for TAI versus continuing SBC alone.

CONCLUSION: TAI is a cost-saving treatment strategy reducing risk of stoma surgery, UTIs, episodes of FI and improving QALYs for NBD patients who have failed SBC.

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