title: Cost-effectiveness of an Internet-based treatment program for stress urinary incontinence.
abstract: OBJECTIVE
  To perform a deterministic cost-utility analysis, from a 1-year societal perspective, of two treatment programs for stress urinary incontinence (SUI) without face-to-face contact: one Internet-based and one sent by post. The treatments were compared with each other and with no treatment.
  
  
  METHODS
  We performed this economic evaluation alongside a randomized controlled trial. The study included 250 women aged 18-70, with SUI ≥ 1 time/week, who were randomized to 3 months of pelvic floor muscle training via either an Internet-based program including e-mail support from an urotherapist (n = 124) or a program sent by post (n = 126). Recruitment was web-based, and participants were self-assessed with validated questionnaires and 2-day bladder diaries, supplemented by a telephone interview with a urotherapist. Treatment costs were continuously registered. Data on participants' time for training, incontinence aids, and laundry were collected at baseline, 4 months, and 1 year. We also measured quality of life with the condition-specific questionnaire ICIQ-LUTSqol, and calculated the quality-adjusted life-years (QALYs) gained. Baseline data remained unchanged for the no treatment option. Sensitivity analysis was performed.
  
  
  RESULTS
  Compared to the postal program, the extra cost per QALY for the Internet-based program ranged from 200€ to 7,253€, indicating greater QALY-gains at similar or slightly higher costs. Compared to no treatment, the extra cost per QALY for the Internet-based program ranged from 10,022€ to 38,921€, indicating greater QALY-gains at higher, but probably acceptable costs.
  
  
  CONCLUSIONS
  An Internet-based treatment for SUI is a new, cost-effective treatment alternative.
authors.affiliation: Department of Public Health and Clinical Medicine, Unit of Clinical Research Center - Östersund, Umeå University, Umeå
authors.forename: Malin
authors.initials: M
authors.lastname: Sjöström
authors.forename: Göran
authors.initials: G
authors.lastname: Umefjord
authors.forename: Lars
authors.initials: L
authors.lastname: Lindholm
authors.forename: Eva
authors.initials: E
authors.lastname: Samuelsson
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D003362:Cost-Benefit Analysis; D005260:Female; D017048:Health Care Costs; D006801:Humans; D020407:Internet; D008875:Middle Aged; D019057:Quality-Adjusted Life Years; D011795:Surveys and Questionnaires; D014550:Urinary Incontinence, Stress / Q000191:economics* / Q000628:therapy*; D055815:Young Adult
keywords: Internet; cost-effectiveness; pelvic floor muscle training; self-management; stress urinary incontinence