Eficiência do Continence app® para a prevenção da incontinência urinária em mulheres após o parto: ensaio clínico randomizado e avaliação econômica

Abstract

Study conducted to evaluate the effectiveness of an educational application (Continence App®) to prevent postpartum urinary incontinence (UI) through a multi-method study, consisting of a Randomized Controlled Clinical Trial (ECR) (1st stage) and an economic evaluation in deterministic health (2nd stage). The outcome was considered to be the efficiency of the application to prevent postpartum UI measured by its effects on impact, severity and urinary leakage, in addition to its cost-effectiveness. The RCT performed at the Assis Chateaubriand Maternity School involved a Control Group (CG) that received the usual routine hospital care, and an Intervention Group (IG) that received, in addition to the usual care, the educational intervention mediated by the application. Eighty-four puerperal women were involved in each group, which were compared at baseline and after three months of intervention by nonparametric tests for intra and intergroup comparisons. A qualitative analysis of the speeches of the postpartum women was performed. The economic assessment measured health-related outcomes and the budgetary impact of the application on the Unified Health System (SUS). Costs were expressed in national currency units and outcomes in health benefits. The study was approved by the Research Ethics Committee (CAAE 56539116.4.0000.5054) and registered with the Brazilian Clinical Trials Registry (RBR-5634jr). The groups were homogeneous regarding sociodemographic, sexual, reproductive and urinary characteristics. After the intervention, the prevalence of UI in GI and CG were respectively 16.6% (n = 4) and 39.5% (n = 19) (p = 0.049; 95% CI 0.906-6.083); There was a significant improvement regarding the frequency of urinary leakage (p = 0.049), impact (p = 0.046) and severity (p = 0.04). Of the 24 women investigated regarding the use of the application, 5 (20.8%) did not read all the information cards and only 3 (12.5%) did not finish the exercise program, revealing an adherence of 87.5%. The Number Needed to Treat (NNT) was 5 women, justifying the use of Continence app®, as it is necessary to track a small number of women to prevent one from developing UI. Using the app gives health service users a QALY of 0.0101 and YALY of 0.041 on their survival. The incremental cost-effectiveness ratio per QALY in an application scenario was -R $ 42,823.76 and sensitivity analyzes testing the application effectiveness with a 10- percentage point reduction and increase indicated a potential range of - R $ 92,049.51 to R $ 6,402.00. The data showed that the educational intervention using Continence app® is effective in reducing prevalence, impact, severity and urinary leakage, as well as being cost-effective and capable of being implemented in primary care, positively impacting cost reduction. SUS related to UI. Therefore, it is argued that the use of Continence app® increases quality of life and reduces costs for SUS, and can be used in the postpartum as an additional strategy to prevent UI and reduce the number of costly treatments for the system. of health.