Economic consequences of an implanted neuroprosthesis for bladder and bowel management

Objective: To determine whether an implanted neuroprosthesis for bladder an d bowel management is less costly than conventional techniques. Design: Retrospective cost-identification analysis with comparison before a nd after implantation of the neuroprosthesis. Setting: Life-care planning interviews in patients' homes. Patients: Twelve patients with complete suprasacral spinal cord injuries an d neurogenic bladder and bowel. Intervention: Implantation of a neuroprosth esis for electric stimulation of the sacral nerves and posterior sacral rhi zotomy. Main Outcome Measures: Annual costs of bladder and bowel care with and with out the neuroprosthesis, projected over 10 years. Results: Bladder and bowel care costs were reduced by over 80%, from a medi an of $8152 a year for conventional care to a median of $948 a year. With t he neuroprosthesis, median annual costs for bladder supplies were reduced f rom $3368 to $58; for medications, from $1866 to $108; for medical care, fr om $656 to $96; and for bowel care supplies, from $205 to $87. After 5 year s, the cumulative costs of treatment with the neuroprosthesis, including th e cost of the device and its implantation and maintenance, equaled those of conventional care. Thereafter, savings from the implanted neuroprosthesis are projected to increase progressively throughout the patient's life. Conclusion: A neuroprosthesis implant with posterior rhizotomy greatly redu ces the cost of managing the neurogenic bladder and bowel. (C) 2001 by the American Congress of Rehabilitation Medicine and the American Academy of Ph ysical Medicine and Rehabilitation.