Persistent urinary continence affects over 30% of prostate cancer survivors. “STAY DRY” is an effective new patient-centered intervention, entailing pelvic floor muscle exercise and symptom self-management.
Evaluate the cost-effectiveness of “STAY DRY” intervention in the real world by comparing participating patients in a clinical trial testing this intervention and eligible but nonparticipating patients.
223 participating subjects from two intervention groups (“support group” and “telephone”) and a usual care control group, and 69 nonparticipating subjects were assessed at baseline and 6 months on urinary continence, quality of life and costs. Intervention effectiveness was assessed on US-based EQ-5D index score and incontinence-specific quality-of-life measure (UCLA-UF). The costs included direct health care cost from medical billing data; patient out-of-pocket expense, expense for caregiver, and cost for loss-of-work from self-reported survey; and intervention cost. We calculated incremental cost-effectiveness ratios (ICERs) from societal, provider, and patients’ perspectives.
The two intervention groups had significantly higher EQ-5D index scores (0.054, P=0.033 and 0.057, P=0.027, respectively) than the nonparticipating group at month 6. Intervention cost per subject was $252 and $484 more for providers and $564 and $203 more for the intervention subjects per group within 6 months. Other costs were not significantly different, but the numerical differences were applied for ICER calculations. The final ICERs are $16,759 and $12,561 per quality-adjusted-life-year (QALY) for the two intervention groups compared to the nonparticipating group. These ICERs are much smaller than the $50,000/QALY threshold used as the consensus to determine cost-effectiveness.
“STAY DRY” intervention is cost-effectiverelative to the nonparticipating group mainly because urinary function worsened over time in the nonparticipating group. This finding calls for a change of standard care to provide behavioral treatment of urinary continence to all incontinent prostate cancer patients for improving their quality of life at a low cost.