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

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.

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.

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).

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

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.

Journal of medical economics. 2018 Jul 06 [Epub]

Márcio Augusto Averbeck, Andrei Krassioukov, Nikesh Thiruchelvam, Helmut Madersbacher, Mette Bøgelund, Yasuhiko Igawa

a Neuro-Urology , Moinhos de Vento Hospital , Porto Alegre , Brazil., b International Collaboration On Repair Discoveries (ICORD), Department of Medicine , University of British Columbia and G.F. Strong Rehabilitation Centre , Vancouver , BC , Canada., c Department of Urology, Cambridge University Hospitals NHS Trust , Cambridge , UK., d Department of Neurology , Medical University Innsbruck , Innsbruck , Austria., e Incentive Partners ApS , Holte , Denmark., f Department of Continence Medicine , The University of Tokyo , Graduate school of Medicine , Tokyo , Japan.