Introduction
Urinary incontinence (UI) affects one in three women and causes a loss of quality of life. This is compounded by the fact that many women experience barriers to seeking help1 and often receive suboptimal care when they seek care from a general practitioner (GP).2,3 These factors can lead both to avoidable suffering if symptoms persist and to unnecessarily high costs for society when inadequate treatment results in limited benefit.
An eHealth application for the treatment of incontinence may not only improve care but also reduce costs by offering an accessible and effective standalone strategy. For this reason, we have developed an app to guide the treatment of women with stress, urgency, and mixed UI. Although digital content and care-as-usual are delivered differently, the content of the app has been carefully designed to reflect that of relevant Dutch and International guidelines for pelvic floor muscle training (PFMT) and bladder training. 4,5 In a qualitative study, we showed that this digital approach to content delivery and treatment was appreciated by women who reported that they expected it to help lower barriers to seeking help, increase self-awareness, and provide support with treatment adherence.6 Subsequently, in a pragmatic randomised controlled trial, we also confirmed the short-term effectiveness of app-based treatment compared to care-as-usual for treating UI in general practice over 4 months.7 In that research, app-based treatment was not inferior to care-as-usual and both treatments produced clinically significant decreases in the severity of incontinence, consistent with the results of two Swedish trials showing the effectiveness of an internet-based programme and mobile app for treating stress UI.8,9 These also reported on the cost-effectiveness of their approach for stress UI compared to postponed treatment or a postal-based programme.10,11
The long-term effectiveness and cost-effectiveness of an eHealth application for all common types of UI have not been compared to care-as-usual. However, such a comparison is important if we are to decide whether large-scale implementation is worthwhile from a societal perspective. In the current study, we therefore aimed to assess the long-term effectiveness, costs, and cost-effectiveness of our app-based treatment compared to care-as-usual by GPs.