Table of Contents
Journal of Geriatrics
Volume 2015, Article ID 703425, 7 pages
http://dx.doi.org/10.1155/2015/703425
Research Article

Treating Urge Incontinence in Older Women: A Cost-Effective Investment in Quality-Adjusted Life-Years (QALY)

1Department of Health Policy and Management, Rollins School of Public Health, Emory University, Atlanta, GA 30322, USA
2Department of Healthcare Policy and Research, School of Medicine, Virginia Commonwealth University, Richmond, VA 23298, USA
3Crozer Chester Medical Center, Upland, PA 19013, USA
4Birmingham/Atlanta Veterans Affairs Geriatric Research, Education, and Clinical Center, Birmingham, AL 35233, USA
5Department of Medicine, University of Alabama at Birmingham, Birmingham, AL 35294, USA

Received 6 November 2014; Accepted 16 January 2015

Academic Editor: Ian Stuart-Hamilton

Copyright © 2015 Victoria L. Phillips et al. This is an open access article distributed under the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

Abstract

Objectives. To conduct cost-effectiveness analyses of urge incontinence treatments for older women. Methods. Decision-analytic models assessed three treatment pathways: (1) limited behavioral therapy (LBT); (2) full behavioral therapy (FBT) with biofeedback; and (3) drug (DRUG), with allowances for crossover options following initial treatments. Model inputs were gathered from published data. Cost data were based on third party payer reimbursement. Outcomes were measured as the number of incontinence episodes avoided and quality-adjusted life years gained (QALYs). Results. At baseline values costs per QALY gained ranged from US$3696 to $10609. LBT was the least costly with the lowest benefit. Switching from LBT to FBT, with the greatest gain, was $415 per additional QALY. DRUG was the most expensive option. Sensitivity analyses showed that only small changes in key inputs were required for DRUG to generate greater gains than FBT. Medication costs had to fall substantially for DRUG to be cost competitive. Conclusion. All treatment strategies provide QALYs gains at a bargain price, compared to the standard of US$50,000 per QALY gained. No single treatment strategy dominated under all conditions. Clinicians should offer multiple treatment options to older women with urge incontinence.