Economic consequences of an implanted neuroprosthesis for bladder and bowel management

Objective: To determine whether an implanted neuroprosthesis for bladder and bowel management is less costly than conventional techniques. Design: Retrospective cost-identification analysis with comparison before and after implantation of the neuroprosthesis. Setting: Life-care planning interviews in patients' homes. Patients: Twelve patients with complete suprasacral spinal cord injuries and neurogenic bladder and bowel. Intervention: Implantation of a neuroprosthesis for electric stimulation of the sacral nerves and posterior sacral rhizotomy. Main Outcome Measures: Annual costs of bladder and bowel care with and without the neuroprosthesis, projected over 10 years. Results: Bladder and bowel care costs were reduced by over 80%, from a median of $8152 a year for conventional care to a median of $948 a year. With the neuroprosthesis, median annual costs for bladder supplies were reduced from $3368 to $58; for medications, from $1866 to $108; for medical care, from $656 to $96; and for bowel care supplies, from $205 to $87. After 5 years, the cumulative costs of treatment with the neuroprosthesis, including the 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 reduces the cost of managing the neurogenic bladder and bowel. (C) 2001 by the American Congress of Rehabilitation Medicine and the American Academy of Physical Medicine and Rehabilitation.