title: Cost-effectiveness of a behavioral intervention for persistent urinary incontinence in prostate cancer patients.
abstract: OBJECTIVE
  The aim of this study was to evaluate the cost-effectiveness of a behavioral intervention for urinary incontinence of prostate cancer patients. Study subjects were either participating in or eligible but declined (i.e., nonparticipating) the active intervention study.
  
  
  METHODS
  The intervention-participating subjects were randomized into three groups, including two intervention groups (support and telephone groups) and a usual care reference group. Intervention-nonparticipating subjects were concurrently enrolled. Intervention effectiveness was assessed on the EQ-5D measure. The costs included direct healthcare cost from medical billing data, patient out-of-pocket expense, caregiver expense, patient loss-of-work cost, and intervention cost. We calculated incremental cost-effectiveness ratios (ICERs) from societal, provider, and patient perspectives.
  
  
  RESULTS
  Two hundred and sixty-seven intervention-participating and 69 intervention-nonparticipating post-cancer treatment patients were included. The support and telephone groups, but not the usual care group, had significantly higher EQ-5D index scores (0.054, p = 0.033, and 0.057, p = 0.026, respectively) than the intervention-nonparticipating group at month 6. Within 6 months, intervention cost per subject was $252 and $484, respectively, for providers, and $564 and $203, respectively, for the support and phone group subjects. The final ICERs were $16,759 per quality-adjusted life year (QALY) and $12,561/QALY for support and telephone groups, compared with those of the intervention-nonparticipating group. These ICERs are much smaller than $50,000/QALY, the consensus threshold to determine cost-effectiveness for society.
  
  
  CONCLUSIONS
  The study interventions are cost-effective in consideration of eligible patients who declined the interventions. The interventions can provide meaningful outcome improvement on urinary continence at a low cost. This evidence provides critical information for future health policy decision-making of healthcare providers and payers.
authors.affiliation: Frances Payne Bolton School of Nursing, Case Western Reserve University, Cleveland, OH, USA.
authors.forename: Amy Y
authors.initials: AY
authors.lastname: Zhang
authors.affiliation: Department of Oncology, Georgetown University Medical Center, Washington, DC, USA.
authors.forename: Alex Z
authors.initials: AZ
authors.lastname: Fu
mesh_terms: D000368:Aged; D003362:Cost-Benefit Analysis; D017048:Health Care Costs; D005102:Health Expenditures; D006801:Humans; D008137:Longitudinal Studies; D008297:Male; D008875:Middle Aged; D011468:Prostatectomy / Q000009:adverse effects*; D011471:Prostatic Neoplasms / Q000191:economics / Q000523:psychology*; D019057:Quality-Adjusted Life Years; D018434:Sickness Impact Profile; D013689:Telephone; D016896:Treatment Outcome; D014549:Urinary Incontinence / Q000191:economics / Q000209:etiology* / Q000534:rehabilitation*