Economic considerations and outcome measurement in urge incontinence. Discussions. Question and answer section

Objectives.Urge incontinence exacts a physical, psychological, and economic toll on affected individuals. This article examines different approaches to estimate the burden of urge incontinence on patients and discusses how costs and consequences of treatments can be evaluated and compared to other interventions. Methods.Willingness-to-pay methodology was used in Sweden to illustrate patients' distress. Incontinence symptoms were compared to willingness-to-pay amounts and to health-related quality of life (QOL) as measured with a generic profile (SF-36) and a preference-based instrument (EuroQol). These measures were also tested using data from a clinical trial in the United States. A single effectiveness measure (normal days) that would be meaningful to patients, physicians, and payers and could be used in cost-effectiveness analysis was tested in a multinational clinical trial. Results.Willingness to pay was significantly correlated with the expected health improvement, incontinence symptoms, and income. SF-36 scores were significantly lower than for the general Swedish population and were correlated with the severity of symptoms. Utility values obtained with EuroQo were also correlated with symptoms. Similar results were obtained in the clinical trial. The composite effectiveness measure was able to discriminate between treatment and placebo, despite a high placebo effect. Conclusions.Patients with urge incontinence experience a number of different symptoms that affect activities of daily living and QOL. However, for cost-effectiveness analysis these symptoms should be expressed as a single outcome in order to allow for comparison within the same indication and to other diseases. We tested a disease-specific measure for incontinence and several generic measures to be used in cost-effectiveness analysis.