Marc den Heijer

and 4 more

Objectives: Existing knowledge on Health Related Quality of Life (HRQoL) after surgical removal of sinonasal inverted papilloma (IP) is limited. Moreover, predictors for a better or worse postoperative HRQoL outcome are not known. Our aim was to assess HRQoL in all three health domains (physical, psychological and social), track its postoperative trajectory, investigate if preoperative observations could predict distinct postoperative HRQoL outcomes, and evaluate whether physicians’ interventions could contribute to improved postoperative HRQoL. Design: Prospective cohort study. Setting: Tertiary referral hospital. Participants: Seventy-four patients who underwent surgery for an IP were included. They were asked to fill in the Endonasal Endoscopic Sinus and Skull Base Surgery Questionnaire (EES-Q) preoperatively, and then two weeks, three months, and one year postoperatively. Main outcome measures: Linear mixed models (LMM) analyses were performed to evaluate the overall postoperative HRQoL and the separate health domains, as well as the impact of specific variables (sex, age, ASA classification, smoker, Krouse staging, preoperative EES-Q score, type of surgery and postoperative antibiotics) on HRQoL improvement. Results: The total EES-Q score (P<.001) as well as the physical (P<.001), psychological (P=.049), and the social (P=.002) domains significantly improved postoperatively. ASA classification (P=.049), preoperative EES-Q score (P<.001) and postoperative antibiotics (P=.036) were significant variables. Conclusions: Overall HRQoL, as well as each of the three health domains, improved significantly. A higher ASA score, a higher preoperative EES-Q score, and the administration of postoperative antibiotics were significant predictors for better HRQoL recovery postoperatively. Further research is necessary to confirm these results.

Anne Loohuis

and 7 more

Objective: Long-term cost-effectiveness of app-based treatment for female stress, urgency, or mixed urinary incontinence (UI) compared to care-as-usual in primary care. Design: A pragmatic, randomised controlled, superiority trial. Setting: Primary care in the Netherlands from 2015 to 2018, follow-up at 12 months. Population: Women with ≥2 UI-episodes per week, access to mobile apps, wanting treatment. 262 women randomised equally to app or care-as-usual; 89 (68%) and 83 (63%) attended follow-up. Methods: The standalone app included conservative management for UI with motivation aids (e.g., reminders). Care-as-usual delivered according to the Dutch GP guideline for UI. Main outcome measures: Effectiveness assessed by the change in symptom severity score (ICIQ-UI-SF) and the change in quality of life (ICIQ-LUTS-QoL, EQ-5D-5L) on superiority with linear regression on an intention-to-treat basis. Cost-effectiveness and -utility from a societal perspective, based on Incontinence Impact Adjusted Life Years (IIALYs) and Quality Adjusted Life years (QALYs). Results: Clinically relevant improvement of UI severity for both app (-2.17 ± 2.81) and care-as-usual (-3.43 ± 3.6), with a non-significant mean difference of 0.903 (-0.66 to 1.871). Costs were lower for app-based treatment with \euro-161 (95%CI: -180 to -151) per year. Cost-effectiveness showed small mean differences in effect for IIALY (0.04) and QALY (-0.03) and thus larger ICER (-3,696) and ICUR (\euro6,379). Conclusion: App-based treatment is a viable alternative to care-as-usual for UI in primary care in terms of long-term cost-effectiveness. Funding: Dutch Organisation for Health Research and Development (ZonMw: 837001508), sub-funding P.W. Boer Foundation Dutch Trial Register identifier: Trial NL4948 (www.trialregister.nl/trial/4948).