Economic Analysis of the EPRIDE

尿失禁(Ul)是女性中常见的问题，会导致痛苦并限制日常功能。UL的成本是巨大的，在美国每年占160亿至320亿美元，比所有乳腺癌和妇科癌症的年直接成本总和还要多。UL在很大程度上影响生活质量，并与严重受损的健康状况有关，类似于阿尔茨海默病和中风。较高的体重会增加下尿路感染的风险，初步数据表明体重减轻会改善下尿路感染。为了进一步评估减肥治疗尿失禁的疗效，NIDDK正在赞助通过饮食和锻炼减少尿失禁计划(PROID)，这是一项针对330名患有尿失禁的肥胖女性的研究，随机分为减肥计划或对照条件(关于饮食和锻炼的信息会议和讲义)。虽然减肥计划成本高昂，但它有可能改善Ul，降低与Ul和肥胖症相关的成本，并提高生活质量。这项拟议研究的目的是E-Pride(经济 Pride的分析)，是比较Pride减肥和控制的成本和收益 评估失禁减肥成本效用的干预措施。大小便失禁和肥胖带来的高昂的经济和生活质量成本，以及随着体重减轻而改善的可能性很高，这使得这一领域成为一个需要进行成本效益分析的重要领域。由于公用事业获取了所有潜在的与健康相关的好处，包括改善UL和减轻体重，成本-效用分析是检验以下假设的理想方法：减肥将具有与当前接受的医疗干预措施相当的每质量调整生命年(QALY)的成本。进行这种经济分析的必要步骤是：1)确定与减肥和对照组相关的成本；2)评估与健康相关的生活质量(公用事业) 与治疗和结果相关；以及3)估计减肥计划与控制条件的成本效用。为了评估Ul变化的具体贡献，二次分析将探索费用、与健康相关的生活质量和QALY的变化与Ul和体重变化的关系。E-Pride汇集了一群在经济学、成本效益、Ul和肥胖症治疗方面具有专业知识的高级调查人员。E-Pride的辅助研究使我们能够有效地评估一种新的治疗方法--减轻体重--治疗失禁的成本效益。

Urinary incontinence (Ul) is a common problem among women that causes distress and limits daily functioning. The costs of Ul are substantial, accounting for $16 to $32 billion per year in the U.S., more than the annual direct costs for all breast and gynecological cancers combined. Ul substantially affects quality of life and is associated with severely impaired health status similar to Alzheimer's disease and stroke. Higher weight increases the risk of Ul and initial data suggest that weight reduction improves Ul. To further evaluate the efficacy of weight loss for Ul treatment, the NIDDK is sponsoring the Program to Reduce Incontinence by Diet and Exercise (PRIDE), a study of 330 obese women with Ul randomized to a weight reduction program or control condition (informational sessions & handouts on diet and exercise). While a weight loss program is costly, it has the potential to improve Ul, decrease costs associated with both Ul and obesity and improve quality of life. The aim of this proposed study, E-PRIDE (Economic analysis of the PRIDE), is to compare the costs and benefits of the PRIDE weight loss and control interventions to estimate the cost-utility of weight loss for incontinence. The high economic and quality of life costs of incontinence and obesity and the high probability of improvement with weight loss make this an important area to explore with cost-utility analysis. Since utilities capture all potential health-related benefits, including improved Ul and reduced weight, cost-utility analysis is an ideal method to test the hypothesis that weight loss will have a cost per quality adjusted life year (QALY) that is comparable with currently accepted medical interventions. The steps necessary to perform this economic analysis are to 1) determine costs associated with the weight loss and control groups; 2) assess the health-related quality of life (utilities) associated with treatments and outcomes; and 3) estimate the cost-utility of the weight reduction program vs. the control condition. To evaluate the specific contributions of changes in Ul, secondary analyses will explore the association of changes in costs, health-related quality of life and QALY's with changes in Ul and weight. E-PRIDE brings together a group of senior investigators with expertise in economics, cost-effectiveness, Ul and obesity treatment. The E- PRIDE ancillary study allows us to efficiently evaluate the cost-utility of a novel treatment approach - weight reduction -- for incontinence.