Cost‐effectiveness analysis of open colposuspension versus laparoscopic colposuspension in the treatment of urodynamic stress incontinence

Dumville, Jo C; Manca, Andrea; Kitchener, Henry C; Smith, Anthony; Nelson, Louisa; Torgerson, David

doi:10.1111/j.1471-0528.2006.01036.x

Cited by 36 publications

(34 citation statements)

References 33 publications

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“…Five studies reported whether the difference between treatment groups was significant for both EQ-5D and for other measures (clinical, disease specific measures and generic HRQoL) [11,17,18,22,23]. In three studies there were no statistically significant differences in EQ-5D between treatment groups and this agreed with the other trial outcomes [17,18,22].…”

Section: Resultsmentioning

confidence: 55%

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A review of the psychometric performance of the EQ-5D in people with urinary incontinence

Davis

Wailoo

2013

Health and Quality of Life Outcomes

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Urinary incontinence can cause embarrassment and can impact on daily activities and quality of life. Generic health related quality of life instruments, such as the EQ-5D, are designed to be applicable across a variety of disease areas. However, it is sometimes claimed that they are not applicable to a certain disease area because they are missing a domain which directly captures the impact of that particular disease. For example, none of the domains of the EQ-5D relate directly to incontinence, although the impact of incontinence on quality of life may be expected to be picked up indirectly through changes in domains such as usual activities or anxiety/depression. The objective of this review was to examine the appropriateness of the EQ-5D in people with urinary incontinence by reviewing published evidence relating to the psychometric performance of the EQ-5D. A systematic search was conducted to identify studies reporting data that permitted assessment of the construct validity, responsiveness or reliability of the EQ-5D in people with urinary incontinence. Included papers were those that reported EQ-5D alongside other measures of health related quality of life or clinical measures in patients with urinary incontinence or in a broader population where results were reported for a subgroup of patients with urinary incontinence. Data were extracted and a narrative synthesis was undertaken. Seventeen papers were included in the review. In most of the tests performed, EQ-5D was consistent with clinical or disease specific outcome measures. The EQ-5D demonstrated validity in the majority of ‘known group’ comparisons, although statistical significance was not always reported. Correlations between the EQ-5D and disease specific outcomes were statistically significant and in the expected direction for most but not all of the disease specific instruments and clinical measures. For responsiveness, there was general agreement between changes in EQ-5D and changes in clinical or disease specific measures. Evidence on reliability was limited to one study. The EQ-5D was generally found to perform well on tests of construct validity, responsiveness and reliability, in people with urinary incontinence although no definitive conclusion can be made on its appropriateness based on these measures alone.

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Section: Resultsmentioning

confidence: 55%

“…In addition to the EQ-5D, five studies administered the SF36 or some variant of it [8,10,14,17,18]. One included SF-6D, AQoL, AQoL-8, and HUI-3 [2] and one reported the 15-D [9].…”

Section: Resultsmentioning

confidence: 99%

A review of the psychometric performance of the EQ-5D in people with urinary incontinence

Davis

Wailoo

2013

Health and Quality of Life Outcomes

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“…A review of the Cost-Effectiveness Analysis Registry 167 using the terms 'overactive bladder', 'urinary incontinence' and 'detrusor overactivity' was performed to identify relevant utility weights for the outcomes experienced at a time point beyond the primary study end point. Eighteen studies [168][169][170][171][172][173][174][175][176][177][178][179][180][181][182][183][184][185][186] were identified and utility weights from one study 168 were selected to represent the QoL for subjective cure. This study was selected because the utility values were obtained with a sound theoretical approach (time trade-off) and were relevant to the symptoms of OAB and the type of interventions modelled.…”

Section: Discussionmentioning

confidence: 99%

“…169 Utility weights from other studies were not considered, either because they were focusing on a population with OAB that was undergoing conservative treatments rather than invasive [170][171][172][173][174][175][176] or because they were focusing on women with SUI. [177][178][179][180][181][182] In four more studies, [183][184][185][186] the values of 0.95 and 0.73 were used to represent the utility of continent and incontinent state for a relevant population and interventions, but these were not considered appropriate because the former value in reality represents the utility weight of people with no chronic condition 187 and the latter is based on women with SUI. 188 In the model, women who remain symptomatic were assumed to maintain their initial QoL, which was informed by the primary study.…”

Section: Discussionmentioning

confidence: 99%

Bladder ultrasonography for diagnosing detrusor overactivity: test accuracy study and economic evaluation

Rachaneni

McCooty

Middleton

et al. 2016

Health Technol Assess

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BackgroundUrodynamics (UDS) has been considered the gold standard test for detrusor overactivity (DO) in women with an overactive bladder (OAB). Bladder ultrasonography to measure bladder wall thickness (BWT) is less invasive and has been proposed as an alternative test.ObjectivesTo estimate the reliability, reproducibility, accuracy and acceptability of BWT in women with OAB, measured by ultrasonography, in the diagnosis of DO; to explore the role of UDS and its impact on treatment outcomes; and to conduct an economic evaluation of alternative care pathways.DesignA cross-sectional test accuracy study.Setting22 UK hospitals.Participants687 women with OAB.MethodsBWT was measured using transvaginal ultrasonography, and DO was assessed using UDS, which was performed blind to ultrasonographic findings. Intraobserver and interobserver reproducibility were assessed by repeated measurements from scans in 37 and 57 women, respectively, and by repeated scans in 27 women. Sensitivity and specificity were computed at pre-specified thresholds. The smallest real differences detectable of BWT were estimated using one-way analysis of variance. The pain and acceptability of both tests were evaluated by a questionnaire. Patient symptoms were measured before testing and after 6 and 12 months using the International Consultation on Incontinence modular Questionnaire Overactive Bladder (short form) (ICIQ-OAB) questionnaire and a global impression of improvement elicited at 12 months. Interventions and patient outcomes were analysed according to urodynamic diagnoses and BWT measurements. A decision-analytic model compared the cost-effectiveness of care strategies using UDS, ultrasonography or clinical history, estimating the cost per woman successfully treated and the cost per quality-adjusted life-year (QALY).ResultsBWT showed very low sensitivity and specificity at all pre-specified cut-off points, and there was no evidence of discrimination at any threshold (p = 0.25). Extensive sensitivity and subgroup analyses did not alter the interpretation of these findings. The smallest detectable difference in BWT was estimated to be 2 mm. Pain levels following both tests appeared relatively low. The proportion of women who found the test ‘totally acceptable’ was significantly higher with ultrasonography than UDS (81% vs. 56%;p < 0.001). Overall, subsequent treatment was highly associated with urodynamic diagnosis (p < 0.0001). There was no evidence that BWT had any relationship with the global impression of improvement responses at 20 months (p = 0.4). Bladder ultrasonography was more costly and less effective than the other strategies. The incremental cost-effectiveness ratio (ICER) of basing treatment on the primary clinical presentation compared with UDS was £491,500 per woman successfully treated and £60,200 per QALY. Performing a UDS in those women with a clinical history of mixed urinary incontinence had an ICER of £19,500 per woman successfully treated and £12,700 per QALY compared with the provision of urodynamic to all women. For DO cases detected, UDS was the most cost-effective strategy.ConclusionThere was no evidence that BWT had any relationship with DO, regardless of the cut-off point, nor any relationship to symptoms as measured by the ICIQ-OAB. Bladder ultrasonography has no diagnostic or prognostic value as a test in this condition. Furthermore, despite its greater acceptability, BWT measurement was not sufficiently reliable or reproducible.Trial registrationCurrent Controlled Trials ISRCTN46820623.FundingThis project was funded by the National Institute for Health Research (NIHR) Health Technology Assessment programme and will be published in full inHealth Technology Assessment; Vol. 20, No. 7. See the NIHR Journals Library website for further project information.

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“…Generic HRQOL measures, such as the questionnaires listed earlier, are thought to be less responsive than condition-specific measures (CSMs) to small changes in health [5,6]. Partly as a consequence of this perception, many randomized controlled trials do not measure QALYs or only use them as a secondary outcome measure [7].…”

Section: Introductionmentioning

confidence: 99%

Exploring the impact of changes in neurogenic urinary incontinence frequency and condition-specific quality of life on preference-based outcomes

et al. 2010

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Cost‐effectiveness analysis of open colposuspension versus laparoscopic colposuspension in the treatment of urodynamic stress incontinence

Cited by 36 publications

References 33 publications

A review of the psychometric performance of the EQ-5D in people with urinary incontinence

A review of the psychometric performance of the EQ-5D in people with urinary incontinence

Bladder ultrasonography for diagnosing detrusor overactivity: test accuracy study and economic evaluation

Exploring the impact of changes in neurogenic urinary incontinence frequency and condition-specific quality of life on preference-based outcomes

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