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An Economic Evaluation of a Web-Based Management Support System for Children With Urinary Incontinence: The eADVICE
Amy Von Huben1,2, Martin Howell1,2, Deborah Richards3
1School of Public Health, The University of Sydney, Sydney, Australia.
Insights
The eADVICE web-based program for children with urinary incontinence is cost-saving and effective. This digital health intervention improves continence and reduces healthcare costs for children awaiting specialist appointments.
Area of Science:
- Digital Health
- Pediatric Urology
- Health Economics
Background:
- Children with urinary incontinence face long waits for specialist care, potentially worsening their condition.
- Timely interventions during the waiting period can improve outcomes and reduce treatment complexity.
- Web-based programs offer a scalable solution for managing chronic pediatric conditions.
Purpose of the Study:
- To evaluate the cost-effectiveness of the eADVICE program for children with urinary incontinence awaiting specialist appointments.
- To compare the eADVICE program with usual care in terms of clinical outcomes and healthcare costs.
- To assess the feasibility of using an embodied conversational agent for delivering a web-based health program.
Main Methods:
- A trial-based cost-effectiveness analysis was conducted as a substudy of a randomized controlled trial.
- The study compared the eADVICE program (supervised by a primary physician and delivered via a conversational agent) to usual care.
- Outcomes included continence status and quality of life, analyzed on an intention-to-treat basis, with uncertainty examined through sensitivity analyses.
Main Results:
- The eADVICE program was found to be cost-saving and beneficial compared to usual care.
- A significantly higher proportion of children achieved dryness for over 14 days at 6 months (risk difference 0.13, P = .03).
- Mean healthcare costs were reduced by $188 per participant.
Conclusions:
- An individualized, evidence-informed, web-based program using an embodied conversational agent is cost-saving for children with urinary incontinence.
- The eADVICE program demonstrates a favorable and substantial economic impact.
- This approach may be transferable to other chronic pediatric health conditions in outpatient settings.
Purpose:
Children who require specialist outpatient care typically wait substantial periods during which their condition may progress, making treatment more difficult and costly. Timely and effective therapy during this period may reduce the need for lengthy specialist care. This study evaluated the cost-effectiveness of an individualized, evidence-informed, web-based program for children with urinary incontinence awaiting a specialist appointment (Electronic Advice and Diagnosis Via the Internet following Computerized Evaluation [eADVICE]) compared to usual care. eADVICE was supervised by a primary physician and delivered by an embodied conversational agent.
Materials And Methods:
A trial-based cost-effectiveness analysis was performed from the perspective of the health care funder as a substudy of eADVICE, a multicenter, waitlist-controlled, randomized trial. Outcomes measures were incremental cost per incremental change in continence status and quality of life on an intention-to-treat basis. Uncertainty was examined using cost-effectiveness planes, scenarios, and 1-way sensitivity analyses. Costs were valued in 2021 Australian dollars.
Results:
The use of eADVICE was found to be cost saving and beneficial (dominant) over usual care, with a higher proportion of children dry over 14 days at 6 months (risk difference 0.13; 95%CI 0.02-0.23, P = .03) and mean health care costs reduced by $188 (95%CI $61-$315) per participant.
Conclusions:
An individualized, evidence-informed, web-based program delivered by an embodied conversational agent is likely cost saving for children with urinary incontinence awaiting a specialist appointment. The potential economic impact of such a program is favorable and substantial, and may be transferable to outpatient clinic settings for other chronic health conditions.
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