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.