Today sees the publication of the National Institute for Health and Care Excellence’s (NICE) medical technology guidance: Peristeen transanal irrigation system for managing bowel dysfunction (MTG36).
Whilst there are currently a number of ways to treat bowel dysfunction for both functional and neurological patients (including changes to a person’s diet and hydration levels and the use of laxatives and pads), many patients remain symptomatic. For some of these patients, transanal irrigation (TAI) with Peristeen offers a cost effective alternative which can help to optimise the emptying of the bowel.
Peristeen is a TAI system manufactured by Coloplast for people suffering from faecal incontinence and constipation. Using Peristeen has been shown to improve bowel emptying and hence minimise the likelihood of involuntary bowel leakage.
The key recommendations in the NICE guidance are:
- There is evidence for adopting Peristeen in children and adults with bowel dysfunction
- Peristeen can reduce the severity of constipation and incontinence, improve quality of life and promote independence
- Peristeen is most effective when it is offered with specialist training for users, carers and NHS staff, and dedicated patient support
- Peristeen is likely to provide additional clinical benefits for patients and the NHS at no additional cost than standard bowel care.
Furthermore, the NICE medical technology advisory committee acknowledged that Coloplast has a range of community-based and non-clinical services for Peristeen users and prescribers. These include a team of specialist nurses in the UK providing training and support for patients, combined with a telehealth programme that provides easily accessible patient support over the phone.
Research has shown that 66 287 people were admitted into hospital in 2014/15 1 because of constipation problems, equating to 182 admissions per day. Of this number, 48 409 (73%) were emergency hospital admissions. Alongside the health complications and physical challenges attached to being constipated, there are also long-term quality of life and wellbeing issues for people with continence problems including anxiety and social exclusion. Appropriate treatment, designed for the individual patient, can therefore have wider implications apart from improving health outcomes.
The publication of this NICE appraisal offers a solution to some of the estimated 1 in 7 adults and 1 in 3 children who suffer from constipation at any one time 2.
Simon Pannett, Coloplast Head of Market Access said, “Peristeen has been in the market for several years now and we are delighted that it has received a positive recommendation in NICE’s Medical Technologies Evaluation Programme (MTEP).
“Transanal irrigation (TAI) systems go a long way to enabling users with bowel dysfunction to lead as normal and dignified lives as possible. Although there are currently several TAI products available, we believe very strongly that ours has the strongest evidence base of its efficacy and acceptability to patients.
“NICE’s rigorous process of review provides users with the assurance that not only are our products of the highest quality but with the appropriate training and use, they should also have good health outcomes.”
Dr Anton Emmanuel, Consultant Gastroenterologist at University College London Hospitals said, “Over the last ten years transanal irrigation has changed the treatment map for patients with bowel dysfunction (patients with constipation and faecal incontinence) whether due to neurological or functional conditions. The NICE appraisal is a critical update of the benefits and cost efficacy of Peristeen, and it will hopefully open up the treatment for those patients whose symptoms are not adequately relieved with current treatments.”
June Rogers MBE, Paediatric Continence Specialist at Bladder and Bowel UK said “This is good news for children and young people with continence problems, who are sometimes sadly forgotten by health services, as the focus often is on adult care.
“Children with chronic constipation resulting in soiling, those born with anorectal malformations and those with a disability, or other problems resulting in no or poor bowel control have had limited treatment options until now. This new NICE guidance means that these young patients will now have another form of treatment available from the NHS. Hopefully this will also reduce the need for them to undergo surgery. It is important now to ensure that all paediatricians, GPs and nurses who work with children and young people are made aware of this promising therapy.”
Brenda Cheer, Paediatric Specialist Continence Nurse from ERIC, The Children’s Bowel and Bladder Charity said “At ERIC we are well aware of the enormous benefit TAI systems offer to children and young people. No child should have to suffer from ongoing faecal soiling; if laxatives and regular, effective toileting do not prevent it then they should be offered a rectal intervention.
“This new NICE guidance will help to spread that message more widely. It will add credibility to the prescription of Peristeen both for long term conditions and for those that require it temporarily to enable the bowel to rehabilitate. TAI is well tolerated by children and young people; we should not shy away from its use.”
Carol Adcock, a spinal cord injury Nurse Specialist with Spinal Injuries Association said “Effective bowel care is crucial in helping spinal cord injured people lead a fulfilled life. Transanal irrigation products like Peristeen are known to be both very effective and popular with spinal cord injured people as they reduce the severity of constipation and incontinence, improve quality of life and promote independence. We’re very happy that NICE has acknowledged the role that Peristeen plays in supporting good bowel function.”
Notes to editors
1 HSCIC, Hospital Episode Statistics, Admitted Patient Care – England 2014-2015 (Primary Diagnosis: 4 Character) https://digital.nhs.uk/catalogue/PUB19124
2 Coloplast (2016) The Cost of Constipation Report https://www.coloplast.co.uk/Global/UK/Continence/Cost_of_Constipation_Report_FINAL.pdf
For more information, contact Gerald Chan firstname.lastname@example.org / 07469154085
Download a copy of the NICE guidance here https://www.nice.org.uk/guidance/MTG36
Access more information on the NICE MTEP programme here https://www.nice.org.uk/about/what-we-do/our-programmes/nice-guidance/nice-medical-technologies-evaluation-programme