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Cost-effectiveness of an Internet-based treatment program for stress urinary incontinence
Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Family Medicine.
Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Family Medicine.
Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine.
Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Family Medicine.
2015 (English)In: Neurourology and Urodynamics, ISSN 0733-2467, E-ISSN 1520-6777, Vol. 34, no 3, 244-250 p.Article in journal (Refereed) Published
Abstract [en]

AIMS: To perform a deterministic cost-utility analysis, from a 1-year societal perspective, of two treatment programs for stress urinary incontinence (SUI) without face-to-face contact: one Internet-based and one sent by post. The treatments were compared with each other and with no treatment.

METHODS: We performed this economic evaluation alongside a randomized controlled trial. The study included 250 women aged 18-70, with SUI ≥ 1 time/week, who were randomized to 3 months of pelvic floor muscle training via either an Internet-based program including e-mail support from an urotherapist (n = 124) or a program sent by post (n = 126). Recruitment was web-based, and participants were self-assessed with validated questionnaires and 2-day bladder diaries, supplemented by a telephone interview with a urotherapist. Treatment costs were continuously registered. Data on participants' time for training, incontinence aids, and laundry were collected at baseline, 4 months, and 1 year. We also measured quality of life with the condition-specific questionnaire ICIQ-LUTSqol, and calculated the quality-adjusted life-years (QALYs) gained. Baseline data remained unchanged for the no treatment option. Sensitivity analysis was performed.

RESULTS: Compared to the postal program, the extra cost per QALY for the Internet-based program ranged from 200€ to 7,253€, indicating greater QALY-gains at similar or slightly higher costs. Compared to no treatment, the extra cost per QALY for the Internet-based program ranged from 10,022€ to 38,921€, indicating greater QALY-gains at higher, but probably acceptable costs.

CONCLUSION: An Internet-based treatment for SUI is a new, cost-effective treatment alternative.

Place, publisher, year, edition, pages
John Wiley & Sons, 2015. Vol. 34, no 3, 244-250 p.
Keyword [en]
cost-effectiveness, Internet, pelvic floor muscle training, self-management, stress urinary incontinence
National Category
Medical and Health Sciences Family Medicine
Research subject
Family Medicine
Identifiers
URN: urn:nbn:se:umu:diva-84401DOI: 10.1002/nau.22540ISI: 000352152900008PubMedID: 24347521OAI: oai:DiVA.org:umu-84401DiVA: diva2:683657
Available from: 2014-01-05 Created: 2014-01-05 Last updated: 2017-12-06Bibliographically approved
In thesis
1. Internet-based treatment of stress urinary incontinence: treatment outcome, patient satisfaction, and cost-effectiveness
Open this publication in new window or tab >>Internet-based treatment of stress urinary incontinence: treatment outcome, patient satisfaction, and cost-effectiveness
2014 (English)Doctoral thesis, comprehensive summary (Other academic)
Abstract [en]

Background Stress urinary incontinence (SUI) is the leakage of urine when coughing, sneezing, or on exertion. It affects 10-35% of women, and can impair quality of life (QOL). First-line treatment is pelvic floor muscle training (PFMT). However, access barriers and embarrassment may prevent women from seeking care. There is a need for new, easily accessible ways to provide treatment.

Aim To evaluate the treatment outcome, patient satisfaction, and cost-effectiveness of an Internet- based treatment programme for SUI.

Methods We recruited 250 community-dwelling women aged 18-70 years, with SUI ≥1/week via our website. Participants were randomised to 3 months of PFMT with either an Internet-based programme (n=124), or a programme sent by post (n=126). We had no-face-to face contact with the participants, but the Internet group received individually tailored e-mail support from an urotherapist. Treatment outcome was evaluated after 4 months with intention-to-treat analysis. After treatment, we telephoned a strategic selection of participants (Internet n=13, postal n=8) to interview them about their experiences, and analysed the results according to grounded theory principles. We also performed a cost-utility analysis with a 1-year societal perspective, comparing the treatment programmes with each other and with a no-treatment alternative. To scrutinize our measure of QOL, we performed a reliability study of the ICIQ-LUTSqol questionnaire.

Results Participants in both intervention groups achieved highly significant improvements (p<0.001) with large effect sizes (>0.8) in the primary outcomes symptom score (ICIQ-UI SF: mean change Internet 3.4 [SD 3.4], postal 2.9 [3.1]), and condition-specific QOL (ICIQ-LUTSqol: mean change Internet 4.8 [SD 6.1], postal 4.6 [SD 6.7]); however, the differences between the groups were not significant. Compared with the postal group, more participants in the Internet group perceived they were much or very much improved after treatment (40.9%, vs. 26.5%, p=0.01), reduced their use of incontinence aids (59.5% vs. 41.4%, p=0.02), and indicated satisfaction with the treatment programme (84.8% vs. 62.9%, p<0.001).

Results from the interviews fell into three categories: about life with SUI and barriers to seeking care; about the treatments and the patient-provider relationship; about the sense of empowerment many women experienced. A core category emerged: “Acknowledged but not exposed.”

The extra cost per quality-adjusted life year (QALY) gained through use of the Internet-based programme compared with the postal programme was €200. The extra cost per QALY for the Internet-based programme compared with no treatment was €30,935.

The condition-specific questionnaire ICIQ-LUTSqol is reliable in women with SUI, with high degrees of agreement between overall scores (Intraclass correlation coefficient 0.95, p<0.001).

Conclusion Internet-based treatment for SUI is a new, effective, and patient-appreciated treatment alternative, which can increase access to care in a sustainable way.

Place, publisher, year, edition, pages
Umeå: Umeå universitet, 2014. 86 p.
Series
Umeå University medical dissertations, ISSN 0346-6612 ; 1621
Keyword
Stress urinary incontinence, Internet, randomised controlled trial, pelvic floor muscle training, self care, quality of life, qualitative research, cost-utility analysis, validation study
National Category
Family Medicine
Research subject
Family Medicine
Identifiers
urn:nbn:se:umu:diva-84405 (URN)978-­91-­7459-­778-­3 (ISBN)
Public defence
2014-01-31, Hörsalen Snäckan (Aulan), hus 16, ingång 6, Östersunds sjukhus, Östersund, 13:00 (Swedish)
Opponent
Supervisors
Available from: 2014-01-10 Created: 2014-01-06 Last updated: 2015-04-29Bibliographically approved

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