The cost‐effectiveness of preoperative testing (basic office assessment vs urodynamics) for stress urinary incontinence in women

• Published in: BJU international Vol. 89; no. 4; pp. 356 - 363
• Main Authors: Weber, A.M., Taylor, R.J., Wei, J.T., Lemack, G., Piedmonte, M.R., Walters, M.D.
• Format: Journal Article
• Language: English
• Published: Oxford, UK Blackwell Science Ltd 01-03-2002; Blackwell
• Subjects: Aged; Biological and medical sciences; Cost-Benefit Analysis; cost‐effectiveness analysis; Decision Trees; Female; Humans; Investigative techniques of renal and urinary tract function; Investigative techniques, diagnostic techniques (general aspects); Medical sciences; Models, Economic; Patient Selection; Preoperative Care - economics; Prospective Studies; Sensitivity and Specificity; stress urinary incontinence; Treatment Outcome; Urinary Incontinence, Stress - economics; Urinary Incontinence, Stress - surgery; Urodynamics; Human; Evaluation; Urinary system disease; Exploration; Urinary tract disease; Voiding dysfunction; Health economy; Adult; Female; Bladder disease; Diagnosis; Urinary stress incontinence; Cost efficiency analysis
• ISSN: 1464-4096; 1464-410X
• DOI: 10.1046/j.1464-4096.2001.01687.x

Objective To compare the cost‐effectiveness of preoperative testing strategies in women with stress incontinence symptoms, as although urodynamic testing is used to improve the diagnostic accuracy in women with incontinence, the clinical and economic consequences of different levels of testing have not been evaluated.
Materials and methods Decision analysis was used to evaluate basic office assessment (BOA) and urodynamic testing for women with stress incontinence symptoms who were candidates for primary surgical treatment. Costs were calculated using the Federal Register. Parameter estimates for the effectiveness of treatment for different diagnoses of incontinence were based on published reports. Incremental cost‐effectiveness was defined as the cost in dollars per additional patient cured of incontinence.
Results Urodynamics did not improve the effectiveness of treatment; both strategies of a BOA and urodynamic testing resulted in a cure rate of 96% after initial and secondary treatments. The mean cost of care (including initial and secondary treatments and outcomes) was similar for the two strategies ($5042 for BOA, $5046 for urodynamic testing). With BOA reduced testing costs were balanced by increased costs for patients who failed the initial treatment. Under baseline assumptions, one additional cure of incontinence (incremental cost‐effectiveness) using the urodynamic strategy cost $3847, compared with BOA. By sensitivity analyses, BOA was less costly than urodynamics when the prevalence of genuine stress incontinence was  80%.
Conclusion These findings do not support the routine use of urodynamics before surgery in women likely to have genuine stress incontinence, and provide the justification for randomized trials of preoperative testing strategies.