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Sacral Anterior Root Stimulation for Neurogenic Bladder

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Morliere and colleagues conducted a cost-utility analysis comparing sacral anterior root stimulation (SARS) with medical treatment (anticholinergics and urinary voiding techniques) for neurogenic bladder and complete spinal cord injury (Morliere et al. 2015; Drummond 2001). A model with a 10-year time horizon was developed using model inputs from published literature, extrapolation and assumptions.  This study was conducted from the perspective of the French health system.  The main clinical outcome of interest was QALYs.  Costs were based on a 12-month comparative observational cost-effectiveness study and extrapolated to 10 years.  This included the cost of treatment and routine care.  Additional long-term costs include the cost of surgical interventions and secondary complications.  Using a base case assuming that SARS was 60% effective (complete and voluntary micturition restored by 1 year), the calculated ICER was 12,710€ per QALY (EUR 2013).  Assuming a willingness-to-pay threshold of 30,000€ per QALY SARS has a 60% probability of being cost-effective.  At a willingness-to-pay threshold of 100,000€ per QALY this probability of being cost-effective increases to 74%. Overall, the results of the sensitivity analysis resulted in a 54% or higher probability of SARS being cost-effective.

In a single study, sacral anterior root stimulation appears to be cost-effective for neurogenic bladder and complete spinal cord injury.