How cost-effective is group-based pelvic floor muscle training (PFMT) for treating urinary incontinence in older women?
Economic evaluation conducted alongside an assessor-blinded, multicentre randomised non-inferiority trial with 1-year follow-up.
A total of 362 women aged ≥ 60 years with stress or mixed urinary incontinence.
Twelve weekly 1-hour PFMT sessions delivered individually (one physiotherapist per woman) or in groups (one physiotherapist per eight women).
Urinary incontinence-related costs per woman were estimated from a participant and provider perspective over 1 year in Canadian dollars, 2019. Effectiveness was based on reduction in leakage episodes and quality-adjusted life years. Incremental cost-effectiveness ratios and net monetary benefit were calculated for each of the effectiveness outcomes and perspectives.
Both group-based and individual PFMT were effective in reducing leakage and promoting gains in quality-adjusted life years. Furthermore, group-based PFMT was ≥ 60% less costly than individual treatment, regardless of the perspective studied: -$914 (95% CI -970 to -863) from the participant's perspective and -$509 (95% CI -523 to -496) from the provider's perspective. Differences in effects between study arms were minor and negligible. Adherence to treatment was high, with low loss to follow-up and no between-group differences.
Compared with standard individual PFMT, group-based PFMT was less costly and as clinically effective and widely accepted. These results indicate that patients and healthcare decision-makers should consider group-based PFMT to be a cost-effective first-line treatment option for urinary incontinence.
ClinicalTrials.govNCT02039830.
Journal of physiotherapy. 2022 Jun 23 [Epub ahead of print]
Licia P Cacciari, Christian Rc Kouakou, Thomas G Poder, Luke Vale, Mélanie Morin, Marie-Hélène Mayrand, Michel Tousignant, Chantale Dumoulin
School of Rehabilitation, Faculty of Medicine, Université de Montréal and Research Center of the Institut universitaire de gériatrie de Montréal, Montréal, Canada., Département d'Économique, Université de Sherbrooke, Sherbrooke, Canada., École de santé publique-Département de gestion, d'évaluation et de politique de santé, Université de Montréal, Montréal, Canada; Centre de recherche de l'Institut universitaire en santé mentale de Montréal, CIUSSS de l'Est de l'île de Montréal, Montréal, Canada., Institute of Health & Society, Newcastle University, Newcastle upon Tyne, UK., School of Rehabilitation, Faculty of Medicine and Health Sciences, Université de Sherbrooke and Research Center of the Centre hospitalier de l'Université de Sherbrooke, Sherbrooke, Canada., Departments of Obstetrics and Gynecology and Social and Preventive Medicine, Université de Montréal and Research Center of the Centre hospitalier de l'Université de Montréal, Montréal, Canada., School of Rehabilitation, Faculty of Medicine, Université de Montréal and Research Center of the Institut universitaire de gériatrie de Montréal, Montréal, Canada. Electronic address: .