Aims: The aim of this thesis was to identify the most cost effective urogynaecological treatment from a range of five standard therapies of 217 female patients, and to test the hypothesis that the conservative treatment of urinary incontinence was more cost effective than surgical or pharmacological interventions, using the cost per Quality Adjusted Life Year (QALY) as a common assessment. Methods: The first step in this process was to determine whether a generic cost effectiveness instrument, the York Quality of Life Questionnaire was sufficiently sensitive to allow its use in the field of urogynaecology. The York Questionnaire was compared with several other quality of life questionnaires and outcome measures that have been previously utilised in urinary incontinence, and was found to be equally sensitive in detecting change in quality of life as a result of treatment. The next step was to measure the costs required to produce this change in quality of life and to calculate the QALY's for five urogynaecological treatments in three prospective trials comprising of: a randomised trial of Nurse Continence Advisor versus Urogynaecologist conservative treatment of urinary incontinence (n=143), a prospective trial of laparoscopic versus open colposuspension (n=62), and the pharmacological treatment of detrusor instability (n=12). Costs assessed included consultation fees, investigations, theatre costs, hospital stay, patient time off work & travel expenses, and reduction in protective pad costs. Results: The cost/QALY for 5 years as a result of each of the five treatments varied from $28,009 for the Nurse Continence Advisor conservative treatment to $134,069 for the open colposuspension treatment. Conclusions: This finding suggests that the conservative treatment of urinary incontinence is the most cost effective, and should be utilised as the first form of treatment. As a consequence, financial resources would be more efficiently utilised in the conservative treatment of urinary incontinence, such as increasing the availability of services offered by Nurse Continence Advisors and physiotherapists.
| Identifer | oai:union.ndltd.org:ADTP/187953 |
| Date | January 2003 |
| Creators | Foote, Andrew, , UNSW |
| Publisher | Awarded by:University of New South Wales. |
| Source Sets | Australiasian Digital Theses Program |
| Language | English |
| Detected Language | English |
| Rights | Copyright Andrew Foote, http://unsworks.unsw.edu.au/copyright |
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