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Cost-effectiveness of an app-based treatment for urinary incontinence in comparison to care as usual in general practice: A pragmatic randomised controlled trial over 12 months
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  • Anne Loohuis,
  • Henk van der Worp,
  • Nienke Wessels,
  • Janny Dekker,
  • Marijke Slieker-ten Hove,
  • Marjolein Berger,
  • Karin Vermeulen,
  • Marco Blanker
Anne Loohuis
University Medical Centre Groningen
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Henk van der Worp
University Medical Centre Groningen
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Nienke Wessels
University Medical Centre Groningen
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Janny Dekker
University Medical Centre Groningen
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Marijke Slieker-ten Hove
ProFundum Institute
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Marjolein Berger
University Medical Centre Groningen
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Karin Vermeulen
University Medical Centre Groningen
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Marco Blanker
University Medical Centre Groningen
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Abstract

Objective: Long-term cost-effectiveness of app-based treatment for female stress, urgency, or mixed urinary incontinence (UI) compared to care-as-usual in 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. 262 women randomised equally to app or care-as-usual; 89 (68%) and 83 (63%) attended follow-up. 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: Effectiveness assessed by the change in symptom severity score (ICIQ-UI-SF) and the change in quality of life (ICIQ-LUTS-QoL, EQ-5D-5L) on superiority with linear regression on an intention-to-treat basis. Cost-effectiveness and -utility from a societal perspective, based on Incontinence Impact Adjusted Life Years (IIALYs) and Quality Adjusted Life years (QALYs). Results: Clinically relevant improvement of UI severity for both app (-2.17 ± 2.81) and care-as-usual (-3.43 ± 3.6), with a non-significant mean difference of 0.903 (-0.66 to 1.871). Costs were lower for app-based treatment with \euro-161 (95%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 ICER (-3,696) and ICUR (\euro6,379). Conclusion: App-based treatment is a viable alternative to care-as-usual for UI in primary care in terms of long-term cost-effectiveness. Funding: Dutch Organisation for Health Research and Development (ZonMw: 837001508), sub-funding P.W. Boer Foundation Dutch Trial Register identifier: Trial NL4948 (www.trialregister.nl/trial/4948).

Peer review status:IN REVISION

02 Feb 2021Submitted to BJOG: An International Journal of Obstetrics and Gynaecology
04 Feb 2021Assigned to Editor
04 Feb 2021Submission Checks Completed
14 Feb 2021Reviewer(s) Assigned
15 Mar 2021Review(s) Completed, Editorial Evaluation Pending
03 Apr 2021Editorial Decision: Revise Major