Economic Analysis of the EPRIDE

尿失禁（Ul）是一个常见的问题，在妇女中引起痛苦和限制日常生活

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.