Group-based pelvic floor muscle training is a more cost-effective approach to treat urinary incontinence in older women: economic analysis of a randomised trial
Article [Version of Record]
Is part of
Journal of physiotherapy ; vol. 68, no. 3, pp. 191-196.Publisher(s)
ElsevierAuthor(s)
Abstract(s)
Question(s): How cost-effective is group-based pelvic floor muscle training (PFMT) for treating urinary
incontinence in older women? Design: Economic evaluation conducted alongside an assessor-blinded,
multicentre randomised non-inferiority trial with 1-year follow-up. Participants: A total of 362 women
aged 60 years with stress or mixed urinary incontinence. Intervention: Twelve weekly 1-hour PFMT
sessions delivered individually (one physiotherapist per woman) or in groups (one physiotherapist per
eight women). Outcome measures: Urinary incontinence-related costs per woman were estimated from a
participant and provider perspective over 1 year in Canadian dollars, 2019. Effectiveness was based on
reduction in leakage episodes and quality-adjusted life years. Incremental cost-effectiveness ratios and net
monetary benefit were calculated for each of the effectiveness outcomes and perspectives. Results: Both
group-based and individual PFMT were effective in reducing leakage and promoting gains in quality-adjusted
life years. Furthermore, group-based PFMT was 60% less costly than individual treatment, regardless of the
perspective studied: –$914 (95% CI –970 to –863) from the participant’s perspective and –$509 (95% CI –523
to –496) from the provider’s perspective. Differences in effects between study arms were minor and
negligible. Adherence to treatment was high, with low loss to follow-up and no between-group
differences. Conclusion: Compared with standard individual PFMT, group-based PFMT was less costly and
as clinically effective and widely accepted. These results indicate that patients and healthcare decisionmakers should consider group-based PFMT to be a cost-effective first-line treatment option for urinary
incontinence. Trial registration: ClinicalTrials.gov NCT02039830