The predictive value of ePAQ in the urodynamic diagnoses in women

Urinary incontinence (UI) is a common, debilitating condition investigated by urodynamics (UDS). UDS is invasive and not 100% accurate and thus less invasive methods such as the electronic Personal Assessment Questionnaire (ePAQ) require further investigation. This thesis involved a systematic review assessing studies reporting on the clinical uses of ePAQ and demonstrated its reliability in assessing quality of life (QoL) but there were no studies found which had assessed predictive ability. The quality and accuracy of UDS traces performed as part of a large diagnostic accuracy study were assessed and recommendations made for improvement in the quality performance. Finally a prospective, consecutive study involving 390 women assessed the ability of ePAQ to predict a diagnosis ofDO on UDS in women with overactive bladder (OAB) and of urodynamic stress incontinence (USI) on UDS in women who have stress urinary incontinence (SUI) and demonstrated fair predictive ability. There was a positive relationship between OAB and SUI scores and a positive UDS diagnosis. Further research is required to assess whether ePAQ can be used in a predictive model with other predictors e.g. symptoms and examination findings to better predict disease and treatment outcomes

Pregnancy and neonatal outcomes of COVID-19: The PAN-COVID study

Objective To assess perinatal outcomes for pregnancies affected by suspected or confirmed SARS-CoV-2 infection. Methods Prospective, web-based registry. Pregnant women were invited to participate if they had suspected or confirmed SARS-CoV-2 infection between 1st January 2020 and 31st March 2021 to assess the impact of infection on maternal and perinatal outcomes including miscarriage, stillbirth, fetal growth restriction, pre-term birth and transmission to the infant. Results Between April 2020 and March 2021, the study recruited 8239 participants who had suspected or confirmed SARs-CoV-2 infection episodes in pregnancy between January 2020 and March 2021. Maternal death affected 14/8197 (0.2%) participants, 176/8187 (2.2%) of participants required ventilatory support. Pre-eclampsia affected 389/8189 (4.8%) participants, eclampsia was reported in 40/ 8024 (0.5%) of all participants. Stillbirth affected 35/8187 (0.4 %) participants. In participants delivering within 2 weeks of delivery 21/2686 (0.8 %) were affected by stillbirth compared with 8/4596 (0.2 %) delivering ≥ 2 weeks after infection (95 % CI 0.3–1.0). SGA affected 744/7696 (9.3 %) of livebirths, FGR affected 360/8175 (4.4 %) of all pregnancies. Pre-term birth occurred in 922/8066 (11.5%), the majority of these were indicated pre-term births, 220/7987 (2.8%) participants experienced spontaneous pre-term births. Early neonatal deaths affected 11/8050 livebirths. Of all neonates, 80/7993 (1.0%) tested positive for SARS-CoV-2. Conclusions Infection was associated with indicated pre-term birth, most commonly for fetal compromise. The overall proportions of women affected by SGA and FGR were not higher than expected, however there was the proportion affected by stillbirth in participants delivering within 2 weeks of infection was significantly higher than those delivering ≥ 2 weeks after infection. We suggest that clinicians’ threshold for delivery should be low if there are concerns with fetal movements or fetal heart rate monitoring in the time around infection

Population expected value of perfect information (EVPI) for the two outcomes of first analysis.

<p>Population expected value of perfect information (EVPI) for the two outcomes of first analysis.</p

Quality of life data.

<p>Quality of life data.</p

Cost-effectiveness acceptability frontier (CEAF) indicating the probability of the optimal test-treat strategy being cost-effective across different willingness to pay thresholds per additional quality-adjusted life-year (QALY).

<p>Cost-effectiveness acceptability frontier (CEAF) indicating the probability of the optimal test-treat strategy being cost-effective across different willingness to pay thresholds per additional quality-adjusted life-year (QALY).</p

Testing and Treating Women after Unsuccessful Conservative Treatments for Overactive Bladder or Mixed Urinary Incontinence: A Model-Based Economic Evaluation Based on the BUS Study

<div><p>Objective</p><p>To compare the cost-effectiveness of bladder ultrasonography, clinical history, and urodynamic testing in guiding treatment decisions in a secondary care setting for women failing first line conservative treatment for overactive bladder or urgency-predominant mixed urinary incontinence.</p><p>Design</p><p>Model-based economic evaluation from a UK National Health Service (NHS) perspective using data from the Bladder Ultrasound Study (BUS) and secondary sources.</p><p>Methods</p><p>Cost-effectiveness analysis using a decision tree and a 5-year time horizon based on the outcomes of cost per woman successfully treated and cost per Quality-Adjusted Life-Year (QALY). Deterministic and probabilistic sensitivity analyses, and a value of information analysis are also undertaken.</p><p>Results</p><p>Bladder ultrasonography is more costly and less effective test-treat strategy than clinical history and urodynamics. Treatment on the basis of clinical history alone has an incremental cost-effectiveness ratio (ICER) of £491,100 per woman successfully treated and an ICER of £60,200 per QALY compared with the treatment of all women on the basis of urodynamics. Restricting the use of urodynamics to women with a clinical history of mixed urinary incontinence only is the optimal test-treat strategy on cost-effectiveness grounds with ICERs of £19,500 per woman successfully treated and £12,700 per QALY compared with the treatment of all women based upon urodynamics. Conclusions remained robust to sensitivity analyses, but subject to large uncertainties.</p><p>Conclusions</p><p>Treatment based upon urodynamics can be seen as a cost-effective strategy, and particularly when targeted at women with clinical history of mixed urinary incontinence only. Further research is needed to resolve current decision uncertainty.</p></div

Table of results.

<p>Table of results.</p

Effectiveness data and other model parameters.

<p>Effectiveness data and other model parameters.</p

Decision sub-tree representing the treatment pathway of women with an urodynamic diagnosis of detrusor overactivity [The + sign denotes similar model structure].

<p>Decision sub-tree representing the treatment pathway of women with an urodynamic diagnosis of detrusor overactivity [The + sign denotes similar model structure].</p

Cost-effectiveness acceptability frontier (CEAF) indicating the probability of the optimal test-treat strategy (i.e. urodynamics) being cost-effective across different willingness to pay thresholds per additional woman successfully treated.

<p>Cost-effectiveness acceptability frontier (CEAF) indicating the probability of the optimal test-treat strategy (i.e. urodynamics) being cost-effective across different willingness to pay thresholds per additional woman successfully treated.</p