• Antoine Bénard, Elise Verpillot, Anne-Sophie Grandoulier, Brigitte Perrouin-Verbe, Geneviève Chêne, Jean-Rodolphe Vignes, and French Study Group on SARS.
• *CHU Bordeaux, Pôle de Santé Publique, USMR et CIC-EC 7, Bordeaux, France; ‡Univ Bordeaux, Bordeaux School of Public Health, Groupe de Recherche Economie et Gestion en Santé Publique (GREGSAP), Bordeaux, France; §CHU Nantes, Service de Médecine Physique et Réadaptation Neurologique, Nantes, France; ¶CHU Bordeaux, Service de Neurochirurgie A, Bordeaux, France; Université Bordeaux, Bordeaux, France.
• Neurosurgery. 2013 Oct 1; 73 (4): 600-8; discussion 608.

BackgroundUrinary disorders account for 10% of deaths in patients with complete spinal cord injury. Sacral anterior root stimulation (SARS) may be a valuable therapeutic option to restore complete and voluntary micturition (CVM), but questions on its cost-effectiveness remain.ObjectiveTo evaluate the cost-effectiveness of SARS to restore CVM in patients with complete spinal cord injury.MethodsWe conducted a nonrandomized, multicenter, parallel-group cohort study comparing SARS vs. current medical treatments with catheterization or reflex micturition. CVM was assessed at 12 months (end of follow-up) by urodynamic examination. Medical and nonmedical costs were measured in the perspective of the French national health insurance. Linear regression models were used to estimate the incremental net benefit ((Equation is included in full-text article.); λ = willingness-to-pay) adjusted for potential confounders, and P (INB >0) (i.e., probability of SARS being cost-effective vs medical treatment) for different values of λ.ResultsTwenty-five patients were included in each group in 2005 to 2009. At inclusion, mean age was 41 years; 45 (90%) patients were male, and 29 (59%) patients were paraplegic. At 12 months, 15 (60%) patients with SARS had a CVM vs. 3 (12%) patients with medical treatment (P < .001). The total mean cost was 42,803 €; and 8762 €, respectively (P < .001). After adjustment for CVM and voiding methods at inclusion, P (INB >0) was 74% at λ = 100,000 €. This probability was 94% in a sensitivity analysis excluding 6 patients presenting a CVM at inclusion.ConclusionThe effectiveness and cost of SARS are much higher than for medical treatment. Our results inform decision makers of the opportunity to reimburse SARS in this vulnerable population.

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