The costs and benefits of physiotherapy as first-line treatment for female stress urinary incontinence

OBJECTIVE: To evaluate the costs and benefits of physiotherapy for stress urinary incontinence (SUI) in Australia. METHODS: We evaluated the costs and benefits of physiotherapy for the treatment of SUI using outcome data from a prospective multicentre observational study conducted in 1999/2000. Women presenting with SUI to physiotherapists trained in continence management in 35 centres across Australia were recruited into the study. The outcomes of treatment were assessed using subjective, objective and quality-of-life measures at the conclusion of treatment and with 12-month follow-up. The number of treatments in an average episode of care was calculated and adverse events were recorded. RESULTS: Of the 274 consenting subjects, 208 completed an episode of physiotherapy care consisting of a median (IQ range) of five (4-6) visits. The estimated average costs for an episode of ambulatory physiotherapy treatment were dollar 302.40. Based on 'intention to treat' principles, 64% of women were objectively cured. There was a clinically and statistically significant improvement (p < 0.05) in all outcomes after treatment and these were maintained at one-year follow-up. No adverse events were reported. CONCLUSIONS AND IMPLICATIONS: Specialised ambulatory physiotherapy for SUI in Australia is a low-cost, low-risk and effective treatment. These results provide evidence to support international recommendations that physiotherapy should be routinely implemented as first-line treatment before consideration of surgery. This information has important economic implications for planning future health services.