OBJECTIVES: Patients who developed low anterior resection syndrome (LARS) often suffer from severe bowel dysfunction leading eventually to stoma surgery. Transanal irrigation could be an effective and safe alternative to stoma surgery. The aim of this study was to estimate the budget impact of introducing transanal irrigation as a treatment option in LARS from the Spanish National Healthcare System (SNHS) perspective.

METHODS: A budget impact model was developed over a 3-year time horizon. The target population was estimated based on the prevalence and incidence of rectal cancer in Spain and the proportion of patients who developed LARS following a rectal resection. Alternative evaluated was the stoma surgery. Eligibility to transanal irrigation and market shares were validated by an expert group. The following direct health costs (€ 2022) were included: medical device, medical visits, pre-surgery tests, surgery, accessories for stoma care and adverse events costs.

RESULTS: The model estimated that 4,184 patients with LARS would be eligible for transanal irrigation and would remain using it in the long term. Implementing transanal irrigations would allow the SNHS to save €34,114,426; €6,741,411 and €6,534,399 in 2024, 2025 and 2026 respectively, leading to an overall cumulative budget reduction of €47,390,235 over the three years. The most significant cost savings were associated with adverse events costs due to the high cost of treating stoma surgery complications like mucocutaneous dehiscence, hernia, malposition, retraction, etc. A total of €39,042,986; €11,672,195 and €11,313,771 would be saved in 2024, 2025 and 2026 respectively.

CONCLUSIONS: This study suggests that introducing transanal irrigation as a treatment option for bowel dysfunction in LARS patients is a sustainable alternative and would generate savings estimated at €47,390,235 during the first three years of its introduction, as well as minimizing the need for invasive surgery.