Malin Sjöström*, Department of Public Health and Clinical Medicine, UmeÃ¥ University, Sweden, Östersund, Sweden Göran Umefjord, Department of Public Health and Clinical Medicine, UmeÃ¥ University, Sweden, UmeÃ¥, Sweden Lars Lindholm, Department of Public Health and Clinical Medicine, UmeÃ¥ University, Sweden, UmeÃ¥, Sweden Eva Samuelsson*, Department of Public Health and Clinical Medicine, UmeÃ¥ University, Sweden, UmeÃ¥, Sweden Track: Research Presentation Topic: Web 2.0 approaches for clinical practice, clinical research, quality monitoring Presentation Type: Oral presentation Submission Type: Single Presentation Building: Sol Principe Room: C - Almudaina Date: 2014-10-09 11:50 AM – 12:35 PM Last modified: 2014-09-10

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Background: Stress urinary incontinence (SUI) is the leakage of urine on sneezing, coughing, or on exertion. It affects 10-35% of women and might impair quality of life (QoL). The first line of treatment is pelvic floor muscle training (PFMT), which improves or cures two thirds of patients. However, access barriers or embarrassment might prevent women from seeking care, and there is a need for new, easily accessible ways to provide treatment.
We have developed an Internet-based treatment programme for SUI based on PFMT. The programme has been evaluated in a randomised controlled trial (RCT), comparing it with a treatment programme sent by post. Participants in both groups achieved highly significant, and clinically relevant, improvements of symptom severity and QoL. However, compared with the postal group, more participants in the Internet group perceived they were much or very much improved after treatment, reduced their use of incontinence aids, and indicated satisfaction with the treatment programme.

Objective: To perform an economic evaluation of an Internet-based treatment programme based on PFMT for SUI.

Methods: This economic evaluation was performed alongside the above-mentioned RCT that was registered at clinical trials (www.clinicaltrials.gov, ID: NCT01032265). We consecutively randomised 250 women aged 18-70, with SUI≥ 1 time/week, to 3 months of PFMT with either the Internet-based treatment programme (n=124), or a treatment programme sent by post (n=126). The Internet group received continuous e-mail support from a urotherapist, whereas the postal group completed the training on their own. We recruited participants via our open access web site. The diagnosis was based on self-assessed validated questionnaires, 2-day bladder diaries, and a telephone interview with a urotherapist. There was no face-to-face contact with the participants at any time. We continuously registered the costs for delivery of treatment, and also collected data on participants’ time for training, incontinences aids, and laundry at baseline, 4 months and 1 year. All costs are given in Euros in the 2010 mid-year level. QoL was measured with the condition-specific questionnaire ICIQ-LUTSqol, and used to calculate the quality-adjusted life-years (QALYs) gained with each treatment.
We performed a deterministic cost-utility analysis with a 1-year societal perspective, comparing the treatments with each other and with no treatment. Ethical approval was obtained from the Regional Ethical Review Board, Umeå University (number 08-124M).

Results: The extra cost per QALY gained through use of the Internet-based programme compared with the postal programme, ranged from €200 to €7,253. The extra cost per QALY gained for the Internet-based programme compared with no treatment, ranged from €10,022 to €38,921.

Conclusion: The extra cost per QALY gained through use of the Internet-based treatment programme is likely to be acceptable in both comparisons. Thus, Internet-based treatment for SUI is a new, cost-effective treatment alternative with the potential to increase access to care for some women.