Abstract
Objectives
Urgency urinary incontinence (UUI) has a substantial impact on patients’ QOL and well-being, and may pose a substantial economic burden on patients and health insurers. We assessed the cost and cost-effectiveness of four conservative treatment modalities for UUI in Israel.
Methods
A total of 164 women were randomly allocated to one of four interventions: drug therapy (DT), bladder training (BT), pelvic floor muscle-training (PFMT), and combined pelvic floor rehabilitation (CPFR) and were followed over a period of 12-months. Resource utilization including physician encounters, dispensed prescriptions, physical therapist treatment and any other medical services was estimated for each study participant. We also estimated the women’s self-reported utilizations of pads, laundry and new underwear. Total costs were calculated by multiplying the volumes of resource utilization by the corresponding unit-prices. We used the bootstrap method to report bias-corrected confidence-intervals of cost estimates. Utility weights were elicited using the EQ-5D questionnaire at baseline, 3-months and 12-months of follow-up.
Results
Women in all four treatment groups showed improvements in QOL from baseline to 12-months (DT:0.87 - 0.93, BT:0.85 to 0.89, PFMT:0.82 - 0.84, CPFR: 0.82 to 0.86). Changes in QOL summary scores from study enrollment and end of follow-up were estimated after correction for potential baseline differences, and were not statistically different among study groups. The mean total cost was somewhat lower for the DT group participants ($1,460), as compared with the three other interventions (range: $1,760-$1,990). These differences, however, were not statistically significant. The mean monthly personal costs were significantly reduced from baseline to 12-months of follow-up in all treatment groups.
Conclusions
The four treatment modalities for treating UUI were equally effective and associated with comparable costs. Therefore, an incremental cost-effectiveness ratio was calculated. Due to the possibility of declining adherence to drug therapy over time, pelvic floor physical therapy can be considered as the first line treatment for UUI.
Urgency urinary incontinence (UUI) has a substantial impact on patients’ QOL and well-being, and may pose a substantial economic burden on patients and health insurers. We assessed the cost and cost-effectiveness of four conservative treatment modalities for UUI in Israel.
Methods
A total of 164 women were randomly allocated to one of four interventions: drug therapy (DT), bladder training (BT), pelvic floor muscle-training (PFMT), and combined pelvic floor rehabilitation (CPFR) and were followed over a period of 12-months. Resource utilization including physician encounters, dispensed prescriptions, physical therapist treatment and any other medical services was estimated for each study participant. We also estimated the women’s self-reported utilizations of pads, laundry and new underwear. Total costs were calculated by multiplying the volumes of resource utilization by the corresponding unit-prices. We used the bootstrap method to report bias-corrected confidence-intervals of cost estimates. Utility weights were elicited using the EQ-5D questionnaire at baseline, 3-months and 12-months of follow-up.
Results
Women in all four treatment groups showed improvements in QOL from baseline to 12-months (DT:0.87 - 0.93, BT:0.85 to 0.89, PFMT:0.82 - 0.84, CPFR: 0.82 to 0.86). Changes in QOL summary scores from study enrollment and end of follow-up were estimated after correction for potential baseline differences, and were not statistically different among study groups. The mean total cost was somewhat lower for the DT group participants ($1,460), as compared with the three other interventions (range: $1,760-$1,990). These differences, however, were not statistically significant. The mean monthly personal costs were significantly reduced from baseline to 12-months of follow-up in all treatment groups.
Conclusions
The four treatment modalities for treating UUI were equally effective and associated with comparable costs. Therefore, an incremental cost-effectiveness ratio was calculated. Due to the possibility of declining adherence to drug therapy over time, pelvic floor physical therapy can be considered as the first line treatment for UUI.
| Original language | American English |
|---|---|
| Pages (from-to) | A632-A633 |
| Journal | Value in Health |
| Volume | 16 |
| Issue number | 7 |
| DOIs | |
| State | Published - Nov 2013 |