Cost‐effectiveness of a behavioral intervention for persistent urinary incontinence in prostate cancer patients

Abstract

Objective To evaluate the cost-effectiveness of a behavioral intervention for urinary incontinence of prostate cancer patients. Study subjects were either participating in or eligible but declined (i.e. nonparticipating) the active intervention study. Methods The intervention-participating subjects were randomized to three groups, including two intervention groups (support and telephone groups) and a usual care reference group. Intervention-nonparticipating subjects were concurrently enrolled. Intervention effectiveness was assessed on the EQ-5D measure. The costs included direct health care cost from medical billing data, patient out-of-pocket expense, caregiver expense, patient loss-of-work cost, and intervention cost. We calculated incremental cost-effectiveness ratios (ICERs) from societal, provider, and patient perspectives. Results 267 intervention-participating and 69 intervention-nonparticipating post-cancer treatment patients were included. The support and telephone groups, but not the usual care group, had significantly higher EQ-5D index scores (0.054, P=0.033; and 0.057, P=0.026, respectively) than the intervention-nonparticipating group at month 6. Within 6 months, intervention cost per subject was $252 and $484 respectively for providers, and $564 and $203 respectively for the support and phone group subjects. The final ICERs were $16,759 per quality-adjusted-life-year (QALY) and $12,561/QALY for support and telephone groups, compared to the intervention-nonparticipating group. These ICERs are much smaller than $50,000/QALY, the consensus threshold to determine cost-effectiveness for society. Conclusions The study interventions are cost-effective in consideration of eligible patients who declined the interventions. The interventions can provide meaningful outcome improvement on urinary continence at a low cost. This evidence provides critical information for future health policy decision-making of health care providers and payers. Trial Registration clinicaltrials.gov Identifier: NCT01365182

Intervenções de enfermagem para incontinência urinária e disfunção sexual após prostatectomia radical

“…Of the 18 articles included, (5)(6)(7)(8)11,12,(17)(18)(19)(20)(21)(22)(23)(24)(25)(26)(27)(28) 17 were found in the electronic databases and one in the references of the selected studies. In the reference lists of the excluded reviews, no study was found that complied with the inclusion criteria set.…”

“…In the reference lists of the excluded reviews, no study was found that complied with the inclusion criteria set. As for the language of the articles, 16 were published in English, (5,6,8,11,12,(17)(18)(19)(20)(21)(22)(23)(24)(25)(26)(27)(28) one in Spanish (7) and one in Portuguese. (23) As for the country where the study was developed, three were developed in Spain, followed by the United States, United Kingdom, Italy, Australia and China, with two studies each, and Brazil, Denmark, Sweden, Norway and The Netherlands, with one study in each country.…”

“…Concerning the year of publication, one study was published in 2018, (11) one in 2017, (17) five in 2016, (18)(19)(20)(21)(22) five in 2015 (5,(23)(24)(25)(26) and six in 2014. (6)(7)(8)12,27,28) As for the evidence level (EL), five studies presented level II, (5,11,12,21,27) ten level VI (17)(18)(19)(20)(21)(22)(23)(24)(25)(26)28) and three level VII. (6)(7)(8) What the strategies for the implementation of the interventions are concerned, Nursing interventions for UI and SD, Nursing interventions for UI and Nursing interventions for SD were the categories created after analyzing the studies.…”

“…The strategies for the implementation of the nursing interventions are: (1) include in the work routine: nursing consultations, telephone calls and home visits (5,7,11,21,22,27) (EL: II, VI, VII), (2) use didactic sources for educative purposes, such as: website, videos, written material (5) (EL: II) and provide a telephone number / e-mail address to allow the patient to express his doubts and concerns (6,8,17,26) (EL: VI, VII). The three strategies are applicable to UI as well as SD.…”

“…Advise him to contract the muscles before and during activities that cause urine leakage, such as coughing and sneezing. (6,21,24,25,27) II, VI, VII Engage the family and teach them the PFME so that they can encourage the patient to perform them. (11) II Provide the patient with written material, containing pictures and details about the execution of the PFME.…”