PP428 Rechargeable Versus Recharge-Free Sacral Neurostimulation: An Australian Health Economics Analysis

Abstract

Introduction

Sacral neuromodulation is a well-established therapy for urinary and fecal incontinence. Currently available sacral neurostimulators require replacement every three to five years due to battery depletion. New rechargeable sacral neurostimulators with a potential 15-year battery life now have regulatory approval in Australia. However, the initial outlay for the device is higher than for the predicate devices. Our objective was to assess the economic value of rechargeable devices, compared with recharge-free implants, and to identify the patients most likely to benefit from the introduction of this novel technology in Australia.

Methods

The Medicare database was reviewed to quantify populations likely to derive benefits from rechargeable technology. Cost minimization and budget impact analyses were conducted from a payer perspective. Cost inputs were derived from Medicare and the Private Hospital Data Bureau. Two scenarios were modeled comparing the three and five-year battery life of the recharge-free devices with 15 years for a rechargeable device. Sensitivity testing was conducted based on potential uptake and dropout rates (due to death, dementia, etc.).

Results

Rechargeable neurostimulators were found to be dominant (cost-saving) in all modeled scenarios, facilitated by a reduction in the frequency of battery replacement procedures and their associated risks for patients. Rechargeability also facilitated higher power settings for optimal symptom control, without trading off device longevity. Younger patients are expected to derive the greatest benefit from the extended battery life as data showed that 40 percent of the implantations were for patients younger than 65 years. The key uncertainty in this analysis was the limited real-world data on patient selection and preferences, which may influence uptake and dropout rates.

Conclusions

Rechargeable sacral neurostimulators deliver cost savings to the healthcare system due to their extended battery life. Fewer replacement surgeries are an important patient-relevant outcome, especially for younger populations. This finding is important because it demonstrates the economic value of rechargeability to payers and provides robust evidence supporting therapy access for privately insured patients in Australia.