title: Markov chain decision model for urinary incontinence procedures.
abstract: Purpose Urinary incontinence (UI) is a common chronic health condition, a problem specifically among elderly women that impacts quality of life negatively. However, UI is usually viewed as likely result of old age, and as such is generally not evaluated or even managed appropriately. Many treatments are available to manage incontinence, such as bladder training and numerous surgical procedures such as Burch colposuspension and Sling for UI which have high success rates. The purpose of this paper is to analyze which of these popular surgical procedures for UI is effective. Design/methodology/approach This research employs randomized, prospective studies to obtain robust cost and utility data used in the Markov chain decision model for examining which of these surgical interventions is more effective in treating women with stress UI based on two measures: number of quality adjusted life years (QALY) and cost per QALY. Treeage Pro Healthcare software was employed in Markov decision analysis. Findings Results showed the Sling procedure is a more effective surgical intervention than the Burch. However, if a utility greater than certain utility value, for which both procedures are equally effective, is assigned to persistent incontinence, the Burch procedure is more effective than the Sling procedure. Originality/value This paper demonstrates the efficacy of a Markov chain decision modeling approach to study the comparative effectiveness analysis of available treatments for patients with UI, an important public health issue, widely prevalent among elderly women in developed and developing countries. This research also improves upon other analyses using a Markov chain decision modeling process to analyze various strategies for treating UI.
authors.affiliation: Department of Operations and Supply Chain Management, University of St. Thomas , Minneapolis, Minnesota, USA.
authors.forename: Sameer
authors.initials: S
authors.lastname: Kumar
authors.affiliation: Division of Health Policy and Management, School of Public Health, University of Minnesota - Twin Cities , Minneapolis, Minnesota, USA.
authors.forename: Nidhi
authors.initials: N
authors.lastname: Ghildayal
authors.affiliation: Division of Health Policy and Management, School of Public Health, University of Minnesota - Twin Cities , Minneapolis, Minnesota, USA.
authors.forename: Neha
authors.initials: N
authors.lastname: Ghildayal
mesh_terms: D000368:Aged; D003362:Cost-Benefit Analysis; D005260:Female; D006801:Humans; D008390:Markov Chains; D008875:Middle Aged; D011446:Prospective Studies; D011788:Quality of Life; D016032:Randomized Controlled Trials as Topic; D053825:Suburethral Slings; D014549:Urinary Incontinence / Q000601:surgery*; D013520:Urologic Surgical Procedures / Q000191:economics / Q000379:methods*
keywords: Comparative effectiveness analysis; Cost utility analysis; Decision making; Markov chain decision model; Stress incontinence; System thinking