Economic burden of long-term treatment of severe fecal incontinence

Introduction: Find out the long-term economic cost associated with the treatment of severe fecal incontinence by SNS versus symptomatic conservative treatment and definitive colostomy. Methods: Detailed descriptive study of the costs of the healthcare process (interventions, consultations, devices, complementary tests, hospitalization, etc.) of 3 treatment alternatives for fecal incontinence using analytical accounting tools of the Health Service based on clinical activity data. The frequency of use of health resources or the quantity of products dispensed in pharmacies (medication, diapers, ostomy material, etc.) was estimated in each case. Costs derived from adverse situations were included. Patients with severe fecal incontinence, defined by a score greater than 9 on the Wexner severity scale, in whom first-line treatments had failed, were included. Data from a consecutive cohort of 93 patients who underwent an SNS between 2002 and 2016 were used; patients who underwent definitive colostomy (n = 2); parastomal hernia (n = 3), and colostomy stenosis (n = 1). Results: The mean cumulative cost in 10 years per patient in each alternative was: s 10,972.9 symptomatic treatment (62% diapers); s 17,351.57 SNS (95.83% interventions; 81.6% devices); s 25,858.54 definitive colostomy (70.4% ostomy material and accessories). Conclusions: Management of severe fecal incontinence implies a great burden in economic terms. The colostomy is the alternative that generates the most direct cost, followed by SNS and symptomatic treatment. (C) 2021 AEC. Published by Elsevier Espana, S.L.U. All rights reserved.