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

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 (sic)5179 (95% CI -17 323 to 36 260). Costs per QALY amounted to (sic) 23 907 (95% CI -124 849 to 121 849). Assuming a ceiling ratio of (sic) 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.