***TASK*** the task is to summarize an input biomedical literature in six sentences 
    ***INPUT*** the input is a biomedical literature 
    ***OUTPUT*** the output is the summary of an input biomedical literature in six sentences 
    ***DOCUMENTATION*** 
    ***EXAMPLES*** 
    Input: Background The aim was to compare effectiveness of group versus individual sessions of physiotherapy in terms of symptoms , quality of life , and costs , and to investigate the effect of patient preference on uptake and outcome of treatment . Methods A pragmatic , multi-centre r and omised controlled trial in five British National Health Service physiotherapy departments . 174 women with stress and /or urge incontinence were r and omised to receive treatment from a physiotherapist delivered in a group or individual setting over three weekly sessions . Outcome were measured as Symptom Severity Index ; Incontinence-related Quality of Life question naire ; National Health Service costs , and out of pocket expenses . Results The majority of women expressed no preference ( 55 % ) or preference for individual treatment ( 36 % ) . Treatment attendance was good , with similar attendance with both service delivery models . Overall , there were no statistically significant differences in symptom severity or quality of life outcomes between the models . Over 85 % of women reported a subjective benefit of treatment , with a slightly higher rating in the individual compared with the group setting . When all health care costs were considered , average cost per patient was lower for group sessions ( Mean cost difference £ 52.91 95 % , confidence interval ( £ 25.82 - £ 80.00 ) ) . Conclusion Indications are that whilst some women may have an initial preference for individual treatment , there are no substantial differences in the symptom , quality of life outcomes or non-attendance . Because of the significant difference in mean cost , group treatment is recommended . Trial Registration Trial Registration number : IS RCT N Background Mobile apps can increase access to care , facilitate self-management , and improve adherence to treatment . Stress urinary incontinence ( SUI ) affects 10 - 35 % of women and , currently , an app with instructions for pelvic floor muscle training ( PFMT ) is available as first-line treatment . A previous r and omized controlled study demonstrated that the app benefitted symptom severity and quality of life ( QoL ) ; in this study we investigate the cost-effectiveness of the app . Objective The objective of this study was to evaluate the health economy of the app for treating SUI . Methods This deterministic cost-utility analysis , with a 1-year societal perspective , compared the app treatment with no treatment .  Health economic data were collected alongside a r and omized controlled trial performed in Sweden from March 2013 to October 2014 . This study included 123 community-dwelling women participants of 18 years and above , with stress urinary incontinence ≥1 time per week . Participants were self-assessed with vali date d question naires and 2-day leakage diaries , and then r and omized to 3 months of treatment ( app group , n=62 ) or no treatment ( controls , n=61 ) . The app focused on pelvic floor muscle training , prescribed 3 times daily . We continuously registered treatment delivery costs . Data were collected on each participant ’s training time , incontinence aids , and laundry at baseline and at a 3-month follow-up . We measured quality of life with the International Consultation on Incontinence Modular Question naire on Lower Urinary Tract Symptoms and Quality of Life , and calculated the quality -adjusted life years ( QALYs ) gained . Data from the 3-month follow-up were extrapolated to 1 year for the calculations . Our main outcome was the incremental cost-effectiveness ratios compared between app and control groups . One-way and multiway sensitivity analyses were performed . Results The mean age of participants was 44.7 years ( SD 9.4 ) . Annual costs were € 547.0 for the app group and € 482.4 for the control group . Annual gains in quality -adjusted life years for app and control groups were 0.0101 and 0.0016 , respectively . Compared with controls , the extra cost per quality -adjusted life year for the app group ranged from −€2425.7 to € 14,870.6 , which indicated greater gains in quality -adjusted life years at similar or slightly higher cost . Conclusions The app for treating stress urinary incontinence is a new , cost-effective , first-line treatment with potential for increasing access to care in a sustainable way for this patient group AIMS To compare the cost-effectiveness ( CE ) of retropubic midurethral sling ( RMS ) versus transobturator midurethral sling ( TMS ) for the treatment of female stress urinary incontinence ( SUI ) . METHODS A Markov chain decision model was created to simulate treatment of SUI with RMS versus TMS .  Costing data were obtained from the Medicare RBRVS . Data regarding the efficacy and complications associated with RMS versus TMS was compiled from a literature review of 21 r and omized RCTs with a minimum of 12 months follow-up , as were corresponding utilities for different continence states . Deterministic and probabilistic estimates of cost-effectiveness ( CE ) for each procedure were calculated and compared , and sensitivity analyses were performed . RESULTS In the base-case deterministic analysis , the efficacy of RMS was 6.275 versus 6.272 QALYs for TMS . QALYs represent a measure of disease burden accounting for both quantity and quality of life lived and are used to assess the monetary value of a medical intervention . The average cost for treatment with  RMS however was higher at $ 9,579 versus $ 9,017 with TMS . TMS was therefore overall more cost-effective than RMS ( CE = $ 1,438/QALY vs. $ 1,527/QALY ) . Sensitivity analysis demonstrated that physician and sling characteristics such as device cost , surgeon fee , efficacy of treatment , operative time , and duration of hospitalization could all affect the relative CE of the therapies . CONCLUSIONS Our study demonstrated that TMS was more cost-effective than RMS as a treatment for female SUI . The efficacy of the two treatments could be affected by physician and sling characteristic factors Background . The aim of this study was to compare  laparoscopic colposuspension with tension‐free vaginal tape ( TVT ) in terms of costs to the county AIMS To determine the 12-month , societal cost-effectiveness of involving urinary incontinence ( UI ) nurse specialists in primary care compared to care-as-usual by general practitioners ( GPs ) . METHODS From 2005 until 2008 an economic evaluation was performed alongside a pragmatic multicenter r and omized controlled trial comparing UI patients receiving care by nurse specialists with patients receiving care-as-usual by GPs in the Netherl and s. One hundred eighty-six adult patients with stress , urgency , or mixed UI were r and omly allocated to the intervention and 198 to care-as-usual ; they were followed for 1 year . Main outcome measures were Quality Adjusted Life Year ( QALY(societal ) ) based on societal preferences for health outcomes ( EuroQol-5D ) , QALY(patient ) based on patient preferences for health outcomes ( EuroQol VAS ) , and Incontinence Severity weighted Life Year ( ISLY ) based on patient-reported severity and impact of UI ( ICIQ-UI SF ) . Health care re source use , patient and family costs , and productivity costs were assessed . Data were collected by three monthly question naires . Incremental cost-effectiveness ratios were calculated . Uncertainty was assessed using bootstrap simulation , and the expected value of perfect information was calculated ( EVPI ) . RESULTS Compared to care-as-usual , nurse specialist involvement costs € 16,742/QALY(societal ) gained . Both QALY(patient ) and ISLY yield slightly more favorable cost-effectiveness results . At a threshold of € 40,000/QALY(societal , ) the probability that the intervention is cost-effective is 58 % . The EVPI amounts to € 78 million . CONCLUSIONS Based on these results , we recommend adopting the nurse specialist intervention in primary care , while conducting more research through careful monitoring of the effectiveness and costs of the intervention in routine practice OBJECTIVE To assess the cost-effectiveness of duloxetine compared with conservative therapy in women with stress urinary incontinence ( SUI ) . METHODS Cost and outcome data were taken from the Stress Urinary Incontinence Treatment ( SUIT ) study , a 12-month , prospect i ve , observational , naturalistic , multicenter , multicountry study . Costs were assessed in UK pound and outcomes in quality adjusted life years using responses to the EuroQol ( EQ-5D ) ; numbers of urine leaks were also estimated . Potential selection bias was countered using multivariate regression and propensity score analysis . RESULTS Duloxetine alone , duloxetine in combination with conservative treatment , and conservative treatment alone were associated with roughly two fewer leaks per week compared with no treatment . Duloxetine alone and with conservative treatment for SUI were associated with incremental quality -adjusted life-years ( QALYs ) of about 0.03 over a year compared with no treatment or with conservative treatment alone . Conservative treatment alone did not show an effect on QALYs . None of the interventions appeared to have marked impacts on costs over a year . Depending on the form of matching , duloxetine either dominated or had an incremental cost-effectiveness ratio ( ICER ) below pound900 per QALY gained compared with no treatment and with conservative treatment alone . Duloxetine plus conservative therapy had an ICER below pound5500 compared with no treatment or conservative treatment alone . Duloxetine compared with duloxetine plus conservative therapy showed similar outcomes but an additional cost for the combined intervention . CONCLUSIONS Although the limitations of the use of SUIT 's observational data for this purpose need to be acknowledged , the study suggests that initiating duloxetine therapy in SUI is a cost-effective treatment alternative OBJECTIVE The objective of the study was to estimate the effect of Burch and fascial sling surgery on out-of-pocket urinary incontinence ( UI ) management costs at 24 months postoperatively and identify predictors of change in cost among women enrolled in a r and omized trial comparing these procedures . STUDY DESIGN Re sources used for UI management ( supplies , laundry , dry cleaning ) were self-reported by 491 women at baseline and 24 months after surgery , and total out-of-pocket costs for UI management ( in 2012 US dollars ) were estimated . Data from the 2 surgical groups were combined to examine the change in cost for UI management over 24 months . Univariate and bivariate changes in cost were analyzed using the Wilcoxon signed rank test . Predictors of change in cost were examined using multivariate mixed models . RESULTS At baseline mean ( ±SD ) age of participants was 53 ± 10 years , and the frequency of weekly UI episodes was 23 ± 21 . Weekly UI episodes decreased by 86 % at 24 months ( P < .001 ) . The mean weekly cost was $ 16.60 ± $ 27.00 ( median $ 9.39 ) at baseline and $ 4.57 ± $ 15.00 ( median $ 0.10 ) at 24 months ( P < .001 ) , a decrease of 72 % . In multivariate analyses , cost decreased by $ 3.38 ± $ 0.77 per week for each decrease of 1 UI episode per day ( P < .001 ) and was strongly associated with greater improvement in Urogenital Distress Inventory and Incontinence Impact Question naire scores ( P < .001 ) and decreased 24-hour pad weight ( P < .02 ) . CONCLUSION Following Burch or fascial sling surgery  , the UI management cost at 24 months decreased by 72 % ( $ 625 per woman per year ) and was strongly associated with decreasing UI frequency . Reduced out-of-pocket expenses may be a benefit of these established urinary incontinence procedures AIM The efficacy , safety and hospital costs of the tension-free vaginal tape procedure were compared with the pubovaginal sling operation . METHODS A total of 60 women urodynamically diagnosed as having stress or mixed urinary incontinence were operated on using either the tension-free vaginal tape or pubovaginal sling operation in a prospect i ve manner . Preoperative characteristics of the women were not significantly different for the groups . The women were followed for up to 24 months . RESULTS In the tension-free vaginal tape group , the operation time was shorter , numbers of analgesics postoperatively required were less and hospital charges were less expensive compared to those in the pubovaginal sling operation ( P < 0.01 ) . Kaplan-Meier survival analysis showed a marginal significant difference ( P = 0.059 ) in the objective cumulative cure rates at 24 months between the groups receiving the former ( 70.3 % ) and latter ( 48.3 % ) procedures . Subjective cure rates were not significantly different ( P = 0.101 ) . In both groups , an improvement in quality of life was significant and surgical complications were identical . De novo urge incontinence developed in 6 % and 10 % in the former and latter , respectively . CONCLUSIONS The tension-free tape was significantly superior to the pubovaginal sling in terms of operation time , postoperative pain , and hospital charges , but not in cure rates . A longer follow up with a larger sample size is necessary to draw definite conclusions AIMS Urodynamic studies ( UDS ) are generally recommended prior to surgical treatment for stress urinary incontinence ( SUI ) , despite insufficient evidence that it impacts treatment plans or outcomes in patients with uncomplicated SUI . This analysis aim ed to calculate the cost incurred when UDS was performed as a supplement to a basic office evaluation and to extrapolate the potential savings of not doing UDS in this patient population on a national basis . METHODS This is a secondary analysis from the Value of Urodynamic Evaluation ( ValUE ) trial , a multicenter 
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Conclusions Heterogeneity was observed in cost estimates for all units at all levels of health care .