Direct costs of female urinary incontinence in italy: an event-tree based model

Hypothesis / aims of study The research aims at developing an original model for the identification, measurement and analysis, in a societal perspective, of the costs that arise from the complex Diagnosis and Treatment Paths (DTPs) of female UI, making distinction between the costs that are borne by the national healthcare system (NHS) and private expenditures. The need for a model derives from three main motivations: i) UI is a very diverse disease: its various types largely differ for their aetiology and subsequent treatments; ii) in many countries (Italy included), it is not possible to obtain complete and detailed information on actual costs, given the absence of precise treatment protocols, a significant diversity among the different regions of the country and the lack of specifically designed cost accounting systems; iii) through a model, it is possible to assess also the costs privately borne by individuals (and their families, employers, etc.). Study design, materials and methods The research has been carried on by an interdisciplinary team, with specialists in the study and treatment of UI and – with a particular focus on the identification, measurement and assessment of the economic dimensions of the DTPs - experts in business economics and accounting. The application of the model has been limited to 18-85 years old women, not living in residential care homes and not affected by disabling or extremely severe diseases. The model is based on a two-dimensional classification of UI (i.e. by type and by age: four main types, anatomic SUI and ISD SUI, UUI and - as a combination of the other types - MUI, and four significant ages, 30, 45, 60 and 75 yrs), defining modules that have been studied and analysed through the Event tree analysis (ETA) method. The event trees start with the first visit with the GP and, after a sequence of events linked by conditional probabilities, lead to a list of possible outcomes, characterised by different probabilities and costs. The combination of events and probabilities of each module depends mainly on the capability of the healthcare system to effectively attract patients and address them towards proper treatments (supply side) and on the awareness and determination of incontinent women, together with their overall trust in the healthcare system (demand side). The direct costs of DTPs have been classified into six broad categories: GP visits, specialist visits, surgical treatments, pharmacological therapy, physical therapy, absorbent and skin protection products. For the definition of the structure of the trees, the probabilities of the events, the identification and estimates of the cost components and their attribution to either NHS or private expenditure, the study has formulated hypotheses in coherence with the existing research (on Italy and other comparable contexts). When it was not possible to rely unambiguously on adequate publications and secondary data, the overall plausibility of the hypotheses has been validated with a wider panel of selected experts.