Cost-effectiveness of a pro-active approach of urinary incontinence in women

Abstract

Objective: To estimate the cost-effectiveness and cost–utility of actively encouraging older community-dwelling women with urinary incontinence to be diagnosed and treated. Design: The study was designed as cost-effectiveness and cost–utility analyses alongside a cluster randomised controlled trial. Analyses were performed from a societal perspective. Direct medical and nonmedical costs were taken into account and valued according to the standard Dutch guidelines for economic evaluations. Setting: Primary care. Population: Study participants were 350 community-dwelling women 55 years or older with urinary incontinence. Methods: Women in the intervention group were invited for diagnostic testing and treatment. The control group received usual care according to the Dutch guideline on urinary incontinence. Follow-up period was 12 months. Main outcome measures: Incontinence Impact Adjusted Life Years (IIALY), Quality Adjusted Life Years (QALY) and incremental costs calculated per IIALY and per QALY gained. Results: Costs per extra life year without impact on daily life from urinary incontinence amounted to €5179 (95% CI −17 323 to 36 260). Costs per QALY amounted to €23 907 (95% CI −124 849 to 121 849). Assuming a ceiling ratio of €20 000, the probability that the intervention was cost-effective based on IIALYs was 91% and 46% based on QALYs. Conclusions: Improvements in severity of incontinence in older community-dwelling women can be achieved against reasonable costs, with an improvement of symptom-specific QALYs. Findings support an active role of primary care physicians towards women who hesitate to ask for help for urinary incontinence. Tweetable abstract: Encouraging women with urinary incontinence to be treated, improves symptoms and QOL against reasonable costs.