Cost-effectiveness of an app-based treatment for urinary incontinence in comparison with care-as-usual in Dutch general practice: a pragmatic randomised controlled trial over 12 months

Abstract

Objective: To assess the cost-effectiveness of app-based treatment for female stress, urgency or mixed urinary incontinence (UI) compared with care-as-usual in Dutch primary care. Design: A pragmatic, randomised controlled, superiority trial. Setting: Primary care in the Netherlands from 2015 to 2018, follow-up at 12 months. Population: Women with ≥2 UI-episodes per week, access to mobile apps, wanting treatment. Methods: The standalone app included conservative management for UI with motivation aids (e.g. reminders). Care-as-usual delivered according to the Dutch GP guideline for UI. Main outcome measures: Costs and cost-effectiveness and -utility were assessed from a societal perspective, based on incontinence impact adjusted life years (IIALYs), quality adjusted life years (QALYs) and medical, non-medical and productivity costs. Information on costs was obtained with the iMCQ and iPCQ questionnaires (medical consumption and productivity cost questionnaires). Results: In all, 262 women were andomised equally to app or care-as-usual; 89 (68%) and 83 (63%) attended follow-up, respectively. Costs were lower for app-based treatment with € −161 (95% confidence interval [CI −180 to −151) per year. Cost-effectiveness showed small mean differences in effect for IIALY (0.04) and QALY (−0.03) and thus larger incremental cost-effectiveness ratios (ICER: −€3696) and incremental cost-utility ratios (ICUR: €6379). Conclusion: App-based treatment is a cost-effective alternative to care-as-usual for women with UI in Dutch primary care. Tweetable abstract: App-treatment for female urinary incontinence cost-effective compared to care-as-usual in general practice after 12 months.