School of Primary and Allied Health Care, Faculty of Medicine, Nursing and Health Sciences, Monash University, Melbourne, Australia; Monash Health Community Continence Service, Specialist Clinics, Monash Health, Melbourne, Australia.
School of Primary and Allied Health Care, Faculty of Medicine, Nursing and Health Sciences, Monash University, Melbourne, Australia.
J Physiother. 2021 Apr;67(2):105-114. doi: 10.1016/j.jphys.2021.03.001. Epub 2021 Mar 23.
What is the most cost-effective way of providing pelvic floor muscle training (PFMT) to prevent or treat postpartum incontinence?
Meta-analysis and cost-effectiveness analysis of models of care included in a recent Cochrane systematic review.
Pregnant and postnatal women.
Supervised PFMT for preventing or treating urinary and/or faecal incontinence.
Postpartum urinary or faecal incontinence.
We examined the comparative incremental cost effectiveness of different approaches to successfully prevent or cure one case of incontinence. Costs were valued in Australian dollars using publicly available market rates and enterprise agreements as of 2019. Comparisons involving group-based treatment approaches were subject to sensitivity analyses where the numbers of patients attending each group were varied to identify thresholds where recommendations change.
Seventeen trials were included for meta-analysis. Three models of care were clinically effective: individually supervised PFMT during pregnancy to prevent urinary incontinence (Model 1), group-based PFMT during pregnancy to prevent or treat urinary incontinence (Model 2) and individually supervised postnatal PFMT to treat urinary incontinence and prevent or treat faecal incontinence (Model 3). The health service costs per urinary incontinence case prevented or cured were $768 for Model 1, and $1,970 for Model 3. However, Model 2 generated a cost saving of $14 if there were eight participants per session, with greater savings if more participants attend. The health service cost per faecal incontinence case prevented or cured was $2,784 (Model 3).
Providing group-based PFMT for all women during pregnancy is likely more efficient than individual PFMT for incontinent women postnatally; however, providing PFMT for postnatal women with urinary incontinence should not be discounted because of the added known benefit for preventing and treating faecal incontinence.
提供盆底肌训练（PFMT）以预防或治疗产后尿失禁的最具成本效益的方法是什么？
对近期 Cochrane 系统评价中包含的护理模式的荟萃分析和成本效益分析。
孕妇和产后妇女。
监督 PFMT 以预防或治疗尿失禁和/或粪便失禁。
产后尿失禁或粪便失禁。
我们检查了不同方法预防或治愈一例失禁的比较增量成本效益。成本使用 2019 年的公开市场费率和企业协议以澳元计价。涉及群体治疗方法的比较进行了敏感性分析，其中对每个群体就诊的患者数量进行了调整，以确定建议改变的阈值。
有 17 项试验被纳入荟萃分析。三种护理模式具有临床疗效：在怀孕期间对个体进行监督性 PFMT 以预防尿失禁（模型 1），在怀孕期间对个体进行监督性 PFMT 以预防或治疗尿失禁（模型 2）以及在产后对个体进行监督性 PFMT 以治疗尿失禁和预防或治疗粪便失禁（模型 3）。预防或治疗每例尿失禁病例的健康服务成本分别为模型 1 为 768 美元，模型 3 为 1970 美元。然而，如果每次治疗有 8 名参与者，模型 2 可以节省 14 美元，如果有更多的参与者参加，则可以节省更多的费用。预防或治疗每例粪便失禁病例的健康服务成本为 2784 美元（模型 3）。
在怀孕期间为所有女性提供群体 PFMT 可能比产后为失禁女性提供个体 PFMT 更有效；然而，由于对预防和治疗粪便失禁的已知益处，不应忽视为产后患有尿失禁的女性提供 PFMT。
