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 (eADVICE) compared to usual care. eADVICE was supervised by a primary physician and delivered by an embodied conversational agent (ECA).
A trial-based cost-effectiveness analysis was performed from the perspective of the healthcare funder as a sub-study 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 ($).
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 (RD 0.13; 95%CI 0.02-0.23, P = .03) and mean healthcare costs reduced by $188 (95%CI $61-$315) per participant.
An individualized, evidence-informed web-based program delivered by an ECA 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.
The Journal of urology. 2024 Apr 11 [Epub ahead of print]
Amy Von Huben, Martin Howell, Deborah Richards, Sana Hamilton, Kirsten Howard, Armando Teixeira-Pinto, Jonathan C Craig, Chris Seton, Karen Waters, Aniruddh Deshpande, Karen M Scott, Patrina H Y Caldwell
School of Public Health, The University of Sydney, Sydney, Australia., School of Computing, Macquarie University, Sydney, Australia., The Children's Hospital at Westmead, Sydney, Australia., College of Medicine and Public Health, Flinders University, Adelaide, Australia., Discipline of Child and Adolescent Health, University of Sydney, Sydney, Australia.