Health economics

Cost effectiveness of transanal irrigation

Bowel dysfunction caused by spinal cord injury has a great impact on the patient’s quality of life. People with this complaint may suffer from constipation, faecal incontinence, and they have to allow more time for defecation. There are also a range of social issues related to bowel dysfunction.

Transanal irrigation reduces the symptoms of neurogenic bowel dysfunction. The product costs related to transanal irrigation are higher than traditional bowel management methods. However, labour costs, treatment costs for urinary tract infections and loss of productivity are lower for transanal irrigation.

A cost-effectiveness analysis of transanal irrigation versus traditional bowel management methods for spinal cord injury patients was carried out in Germany, Italy, Denmark, Sweden and England.

The cost of the two different bowel management methods are presented in the figure below:

	Traditional bowel management	Transanal irrigation
Labour cost: cost of carer helping with bowel management and changes/baths caused by soiling	€ 9	€ 7
Product-related cost: cost related to products used for changes/baths caused by soiling, and products for transanal irrigation and constipation medicine	€ 5	€ 16
Urinary tract infection cost: cost for general practitioner visit, urine test and antibiotics	€ 3	€ 1
Patient’s indirect expenditure: patient productivity loss, (loss of time spent on bowel management)	€ 23	€ 15
Total cost to society	€40	€ 39

Cost reported for a two-day period corresponding to the average interval between bowel management procedures.

The cost-effectiveness analysis shows that the transanal system is both the cheapest and the most effective system for bowel management. For the management of neurogenic bowel dysfunction, transanal irrigation proved more effective than traditional bowel management methods. The overall management cost results show a lower cost per irrigation using transanal irrigation.