Urinary incontinence (UI) is a common problem among women, causing distress and limiting daily activities. The costs of UI are substantial, accounting for $30 billion per year in the U.S., more than for all breast and gynecological cancers combined. Incontinence substantially decreases quality of life and is associated with severely impaired rating of health status similar to Alzheimer's disease and stroke. To evaluate the long-term outcomes of commonly used treatments for female UI, the NIDDK is sponsoring the Urinary Incontience Treatment Network (UITN). The UITN is conducting two randomized clinical trials comparing cure rates of surgeries for stress UI and one trial evaluating the efficacy of drug vs. drug plus behavioral therapy for urge UI. Although interventions for incontinence are costly, they have the potential to improve UI, decrease associated costs and improve quality of life. Yet, are the health benefits of the interventions worth the costs? The goal of this study, the Economic Analyses of the UITN (E-UITN), is to compare the costs and health benefits of the two interventions in each UITN trial.
The specific aims are to 1) describe the effect of UI treatment on UI costs and health-related quality of life;2) assess predictors of changes in UI costs and health-related quality of life following treatment;3) estimate the cost-effectiveness (incremental cost per treatment success, defined by each trial);and 4) estimate the costutility of the alternative interventions (i.e., incremental cost per quality-adjusted life year (QALY)). The primary cost-utility analyses will be within-trial, intention-to-treat analyses conducted from the societal perspective with a two-year time horizon. Additional costutility analyses will use the lifetime time horizon and include disease modeling to assess lifetime costs and benefits. The high economic and quality of life costs of UI and the probability of differential efficacy of the treatments within each study make this an important area to explore with cost-utility analysis. Since utilities capture all potential health-related benefits, cost-utility analysis is an ideal method to test the hypothesis that a more expensive intervention will have an incremental cost per QALY that is comparable with currently accepted medical interventions. The E-UITN offers an efficient opportunity to investigate the costs and cost-utility of treatments for UI. The study assembles a group of senior investigators with expertise in economics, cost-effectiveness and UI treatment. The E- UITN will provide critical economic data for commonly used treatments for incontinence.