TY - JOUR
T1 - Home Biofeedback for the Treatment of Dyssynergic Defecation
T2 - Does It Improve Quality of Life and Is It Cost-Effective?
AU - Rao, Satish S.C.
AU - Go, Jorge T.
AU - Valestin, Jessica
AU - Schneider, John
N1 - Funding Information:
This work was supported by NIH grant RO1 DK 57100-05 and grant RR00059 from the General Clinical Research Centers program, National Center for Research Resources. The study was conducted at the University of Iowa, and data analysis and manuscript writing were completed at the Augusta University and University of Iowa. Grant Support: Dr. Satish Rao is supported by NIH grant R01 DK 57100-05. Portions of this work were presented at the American College of Gastroenterology meeting in San Diego, California, on October 2009, Am J Gastroenterol 2009; 1308:5488, and at the Digestive Disease Week meeting, Chicago, Illinois, on May 2011, Gastroenterology 2011;224:552. We thank Mr. Kice Brown and Dr. B. Zimmerman for support with statistical analysis and QALY measures.
Publisher Copyright:
© 2019 by The American College of Gastroenterology. Unauthorized reproduction of this article is prohibited.
PY - 2019/6/1
Y1 - 2019/6/1
N2 - Biofeedback therapy, whether administered at home or in office settings, is effective for dyssynergic defecation (DD). Whether home biofeedback improves quality of life (QOL) and is cost-effective when compared with office biofeedback is unknown.METHODS:QOL was assessed in 8 domains (SF-36) at baseline and after treatment (3 months), alongside economic evaluation during a randomized controlled trial (RCT) comparing home and office biofeedback in patients with DD (Rome III). Costs related to both biofeedback programs were estimated from the hospital financial records, study questionnaires, and electronic medical records. A conversion algorithm (Brazier) was used to calculate the patient's quality-adjusted life years (QALYs) from SF-36 responses. Cost-effectiveness was expressed as incremental costs per QALY between the treatment arms.RESULTS:One hundred patients (96 female patients, 50 in each treatment arm) with DD participated. Six of the 8 QOL domains improved (P < 0.05) in office biofeedback, whereas 4 of the 8 domains improved (P < 0.05) in home biofeedback; home biofeedback was noninferior to office biofeedback. The median cost per patient was significantly lower (P < 0.01) for home biofeedback ($1,112.39; interquartile range (IQR), $826-$1,430) than for office biofeedback ($1,943; IQR, $1,622-$2,369), resulting in a cost difference of $830.11 The median QALY gained during the trial was 0.03 for office biofeedback and 0.07 for home biofeedback (P = NS). The incremental cost-effectiveness ratio was $20,752.75 in favor of home biofeedback.Discussion:Biofeedback therapy significantly improves QOL in patients with DD regardless of home or office setting. Home biofeedback is a cost-effective treatment option for DD compared with office biofeedback, and it offers the potential of treating many more patients in the community.
AB - Biofeedback therapy, whether administered at home or in office settings, is effective for dyssynergic defecation (DD). Whether home biofeedback improves quality of life (QOL) and is cost-effective when compared with office biofeedback is unknown.METHODS:QOL was assessed in 8 domains (SF-36) at baseline and after treatment (3 months), alongside economic evaluation during a randomized controlled trial (RCT) comparing home and office biofeedback in patients with DD (Rome III). Costs related to both biofeedback programs were estimated from the hospital financial records, study questionnaires, and electronic medical records. A conversion algorithm (Brazier) was used to calculate the patient's quality-adjusted life years (QALYs) from SF-36 responses. Cost-effectiveness was expressed as incremental costs per QALY between the treatment arms.RESULTS:One hundred patients (96 female patients, 50 in each treatment arm) with DD participated. Six of the 8 QOL domains improved (P < 0.05) in office biofeedback, whereas 4 of the 8 domains improved (P < 0.05) in home biofeedback; home biofeedback was noninferior to office biofeedback. The median cost per patient was significantly lower (P < 0.01) for home biofeedback ($1,112.39; interquartile range (IQR), $826-$1,430) than for office biofeedback ($1,943; IQR, $1,622-$2,369), resulting in a cost difference of $830.11 The median QALY gained during the trial was 0.03 for office biofeedback and 0.07 for home biofeedback (P = NS). The incremental cost-effectiveness ratio was $20,752.75 in favor of home biofeedback.Discussion:Biofeedback therapy significantly improves QOL in patients with DD regardless of home or office setting. Home biofeedback is a cost-effective treatment option for DD compared with office biofeedback, and it offers the potential of treating many more patients in the community.
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U2 - 10.14309/ajg.0000000000000278
DO - 10.14309/ajg.0000000000000278
M3 - Article
C2 - 31170114
AN - SCOPUS:85067461150
SN - 0002-9270
VL - 114
SP - 938
EP - 944
JO - American Journal of Gastroenterology
JF - American Journal of Gastroenterology
IS - 6
ER -