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Resumen Objetivo Conocer el coste economico a largo plazo asociado al tratamiento de la incontinencia fecal grave mediante SNS frente al tratamiento conservador sintomatico y la colostomia definitiva. Metodos Estudio descriptivo pormenorizado de los costes del proceso asistencial (intervenciones, consultas, dispositivos, pruebas complementarias, hospitalizacion, etc.) de 3 alternativas de tratamiento de la incontinencia fecal empleando herramientas de gestion y contabilidad analitica del propio Servicio de Salud con base en datos de actividad clinica. Se estimo, en cada caso, la frecuencia de uso de recursos sanitarios o la cantidad de productos dispensados en farmacias (medicacion, panales, material de ostomia, etc.). Se incluyeron costes derivados de situaciones adversas. Se incluyeron pacientes con incontinencia fecal grave, definida por una puntacion superior a 9 en la escala de severidad de Wexner, en los que han fracasado los tratamientos de primera linea. Se emplearon datos de una cohorte consecutiva de 93 pacientes a los que se realizo una SNS entre los anos 2002 y 2016; de pacientes intervenidos de colostomia definitiva (n = 2); hernia paraestomal (n = 3) y estenosis de colostomia (n = 1). Resultados El coste medio acumulado en 10 anos por paciente en cada alternativa fue: 10.972,9 € para el tratamiento sintomatico (62% panales); 17.351,57 € para la SNS (95,83% intervenciones; 81,6% dispositivos), y 25.858,54 € para la colostomia definitiva (70,4% material de ostomia). Conclusiones El manejo de la incontinencia fecal grave implica un gran impacto en terminos economicos. La colostomia es la alternativa que mas costes directos genera, seguida de la SNS y el tratamiento sintomatico.

Find out the long-term economic cost associated with the treatment of severe fecal incontinence by SNS versus symptomatic conservative treatment and definitive colostomy.Detailed descriptive study of the costs of the healthcare process (interventions, consultations, devices, complementary tests, hospitalization, etc.) of 3 treatment alternatives for fecal incontinence using analytical accounting tools of the Health Service based on clinical activity data. The frequency of use of health resources or the quantity of products dispensed in pharmacies (medication, diapers, ostomy material, etc.) was estimated in each case. Costs derived from adverse situations were included. Patients with severe fecal incontinence, defined by a score greater than 9 on the Wexner severity scale, in whom first-line treatments had failed, were included. Data from a consecutive cohort of 93 patients who underwent an SNS between 2002 and 2016 were used; patients who underwent definitive colostomy (n=2); parastomal hernia (n=3), and colostomy stenosis (n=1).The mean cumulative cost in 10 years per patient in each alternative was: € 10,972.9 symptomatic treatment (62% diapers); € 17,351.57 SNS (95.83% interventions; 81.6% devices); € 25,858.54 definitive colostomy (70.4% ostomy material and accessories).Management of severe fecal incontinence implies a great burden in economic terms. The colostomy is the alternative that generates the most direct cost, followed by SNS and symptomatic treatment.