The impact of different scenarios for intermittent bladder catheterization on health state utilities: results from an internet-based time trade-off survey

Abstract

Aims: Intermittent catheterization (IC) is the gold standard for bladder management in patients with chronic urinary retention. Despite its medical benefits, IC users experience a negative impact on their quality of life (QoL). For health economics based decision making, this impact is normally measured using generic QoL measures (such as EQ-5D) that estimate a single utility score which can be used to calculate quality-adjusted life years (QALYs). But these generic measures may not be sensitive to all relevant aspects of QoL affected by intermittent catheters. This study used alternative methods to estimate the health state utilities associated with different scenarios: using a multiple-use catheter, one-time-use catheter, pre-lubricated one-time-use catheter and pre-lubricated one-time-use catheter with one less urinary tract infection (UTI) per year.

Methods: Health state utilities were elicited through an internet-based time trade-off (TTO) survey in adult volunteers representing the general population in Canada and the UK. Health states were developed to represent the catheters based on the following four attributes: steps and time needed for IC process, pain and the frequency of UTIs.

Results: The survey was completed by 956 respondents. One-time-use catheters, pre-lubricated one-time-use catheters and ready-to-use catheters were preferred to multiple-use catheters. The utility gains were associated with the following features: one time use (Canada: +0.013, UK: +0.021), ready to use (all: +0.017) and one less UTI/year (all: +0.011).

Limitations: Internet-based survey responders may have valued health states differently from the rest of the population: this might be a source of bias.

Conclusion: Steps and time needed for the IC process, pain related to IC and the frequency of UTIs have a significant impact on IC related utilities. These values could be incorporated into a cost utility analysis.

Keywords:

• Urinary catheterization
• intermittent catheters
• health state utilities
• quality of life
• cost–utility analysis

JEL classification codes:

• D61
• I12

Transparency

Declaration of funding

Coloplast A/S provided research funding for Incentive Partners Aps for conducting the survey. Editorial services from Marksman Healthcare Communications and a critical scientific review by Andrew Lloyd were additionally supported by funding from Coloplast A/S.

Author contributions: Analysis conception and design, data analysis, manuscript draft preparation: M.A.A., A.K., N.T., H.M., M.B. and Y.I. Data collection, data and analysis tool contribution: M.B. Final draft approval: all authors.

Declaration of financial/other relationships

A.K., M.A.A., N.T. and Y.I. have disclosed that they occasionally provide expert knowledge to advisory boards and educational activities at Coloplast A/S. M.B. has disclosed that she is employed at Incentive Partners Aps. H.M. has disclosed that he has no significant relationships with or financial interests in any commercial companies related to this study or article.

Peer reviewers on this manuscript have received an honorarium from JME for their review work, but have no relevant financial or other relationships to disclose.

Acknowledgements

We gratefully acknowledge the support of Andrew Lloyd, Bladon Associates Ltd, for a critical review of the manuscript and Marksman Healthcare Communications, for editorial services. Jeppe Sørensen and Mia Buus Andersen, Coloplast A/S, contributed to the study design and conducted a scientific review of the manuscript.

Previous presentation: The results have not previously been presented. An abstract based on the initial results from the study (without outlier analysis) was accepted for poster presentation at the ISPOR conference, Baltimore, USA, 19–23 May 2018.