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ESPUN S2: LUT DYSFUNCTION
Moderators: Ellen Janhsen (Germany) & Nathalie Fort (France)
ESPU-Nurses Meeting on Thursday 15, October 2015, 08:20 - 09:00
08:20 - 08:30
ESPUN S2-1
(O)
IS PARASACRAL NEUROMODULATION USING TENS A COST-EFFECTIVE FIRST-
LINE TREATMENT FOR BLADDER OVERACTIVITY IN CHILDREN?
Rebecca HUTCHINSON
1
, Massimo GARRIBOLI
1
, Joanna CLOTHIER
2
and Anne WRIGHT
3
1) Evelina London Children's Hospital - Guy's and St Thomas NHS Foundation Trust, Paediatric Urology, London, UNITED
KINGDOM - 2) Evelina London Children's Hospital - Guy's and St Thomas NHS Foundation Trust, Paediatric Nephrology
and Children's Bladder clinic, London, UNITED KINGDOM - 3) Evelina London Children's Hospital - Guy's and St Thomas
NHS Foundation Trust, Paediatric and Children's Bladder clinic, London, UNITED KINGDOM
PURPOSE
Emerging evidence suggests that parasacral neuromodulation using TENS (TENS) maybe as successful as
anticholinergics (AC) as first-line specific treatment of bladder overactivity after baseline urotherapy. We aimed to
ascertain whether TENS could represent a clinical and cost-effective alternative
MATERIAL AND METHODS
We carried out a retrospective analysis of new referrals in 2014. We reviewed those who have received AC for 6 month
period as first line therapy and proposed that in future these patients would commence on 3 months of TENS as first line
management. We ascertained the individual associated costs of TENS (including disposable components such as
batteries and electrodes) and AC treatment using hospital financial data. We reviewed our response rates to TENS
therapy and used published data for AC.
RESULTS
Of 490 new referrals received in 2014, 90 patients started AC. Fifteen (33%) received Tolterodine tartrate MR 4mg
daily, 15 (33%) Tolterodine tartrate 1-2mg bd, 9 (20%) Oxybutynin 2.5mg tds and 6 (13%) Solifenacin 5mg daily. The
median cost/patient for six months of therapy was £74.00 while the cost/patient of TENS therapy for 3 months is
£33.12. The response rate for AC is 60% (published data) and 54% (based on our patient group). In the analysed
cohort of patients, changing first line management to TENS therapy could lead to a £3679.2 saving (45% cost saving).
CONCLUSIONS
Treatment with neuromodulation TENS provides a slightly lower (54% versus 60%) but quicker (3 months versus 6)
response rate and represents a 45% cost savings compared with six months treatment with an anticholinergic. To
confirm cost-effectiveness of both pathways a prospective randomized controlled trial (neuromodulation vs
anticholinergic) should be considered.