Determining the Health Utility of Urinary Incontinence in Women

Abstract

Results Conclusions Objectives: Health state utility measurements are important in many areas of research and health policy. The current health state utilities available for urinary incontinence have been derived from large scale population based studies without physician confirmation of diagnosis. These studies have also used generic quality of life measures to attempt to quantify a very specific medical condition. The purpose of this study was to compare the health state utility of urinary incontinence in women as derived from the EQ-5D, and visual analog scale (VAS) methods with the gold standard assessment, the Standard Gamble interview. Materials and Methods: This study was approved by the Partners Health Care IRB. Patients were approached for study participation after urodynamic testing confirmed a diagnosis of stress or urge urinary incontinence. Subjects completed the Sandvik Severity Index (SSI), EQ-5D and VAS. Subjects then participated in the Standard Gamble conversation. Results: The median utility for stress incontinence varied based on method: EQ-5D (0.83 [0.23]), VAS (0.85 [0.15]) and standard gamble (1.00 [0.01]). There was a significant difference between the standard gamble assessment and EQ-5D and between the standard gamble and VAS in women with urodynamically demonstrated stress urinary incontinence (p = 0.0003 and p Additionally, they have considered all types of urinary incontinence together. Intuitively, one would think that quality of life would be affected differently with different types (stress, urge, mixed) and differing severity of incontinence. 1. Manca A, Sculpher MJ, Ward K, Hilton P. A cost-utility analysis of tension-free vaginal tape versus colposuspension for primary urodynamic stress incontinence. BJOG 2003;110:255-62. 2. Wu JM, Visco AG, Weidner AC, Myers ER. Is burch colposuspension ever cost- effective compared with tension-free vaginal tape for stress incontinence? AJOG 2007;197:62e1-5. 3. 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Johnson JA, Coons SJ, Ergo A, Szava-Kovats G. Valuation of EuroQOL (ED- 5Q) Health States in an Adult US Sample. Pharmacoeconomics 1998;13:421-3. References  All adult female patients who underwent urodynamic testing at Brigham and Women’s Hospital were prospectively recruited  Diagnosis of type of incontinence was made by attending physician interpretation of the urodynamic study  No exclusion criteria  Patients completed three validated questionnaires 1. Sandvik Severity Index A validated two question symptom specific instrument to evaluate urinary incontinence 2. EQ-5D  A five-domain generic quality of life questionnaire  Answers are converted into a utility value 3. Visual Analog Scale  Vertical line from 0 (worst imaginable health) to 100 (best imaginable health)  Patient rates own perception of health on line  The Standard Gamble technique was used in a standard format to determine each patients utility value for their health state  Patient is asked to choose between life in current health state and varying risks of immediate painless death  Gold Standard method to determine patients utility preference for their health state 0 0.2 0.4 0.6 0.8 1 VAS EQ-5D SG EQ-5D v. SG, p=0.0003* VAS v. SG, p Fig 2. Stress Incontinence Utilities  This pilot study of 28 patients demonstrated a significant difference in utility value derived from the Standard Gamble and the generic health-related quality of life instruments  There were 21 patients with stress urinary incontinence, 6 patients with urge urinary incontinence and 1 patient with mixed urinary incontinence  Mean Sandvik score was higher in Urge Incontinence subgroup  Mean Utility from Standard Gamble was lower in Urge Incontinence group  Sandvik scores were moderately correlated with EQ-5D, SG and VAS utilities Combined Group Stress Incontinence Urge Incontinence Age (y) 55.5 + 15.8 58.9 + 12.9 42.0 + 25.5 BMI (kg/m2) 29.3 + 7.9 29.3 + 8.4 29.2 + 8.3 Menopause 70 % 50% 75% Sandvik 8 + 3 7 + 3 12 + 0 0 0.2 0.4 0.6 0.8 1 VAS EQ-5D SG EQ-5D v. SG, p Fig 1. Urinary Incontinence Utilities Table 1. Demographic Characteristics & Sandvik Score Methods Background