Bladder ultrasonography for diagnosing detrusor overactivity: test accuracy study and economic evaluation
Background: Urodynamics (UDS) has been considered the gold standard test for detrusor overactivity (DO) in women with an overactive bladder (OAB). Bladder ultrasonography to measure bladder wall thickness (BWT) is less invasive and has been proposed as an alternative test. Objectives: To estimate th...
| Main Authors: | , , , , , , , , , , , , , |
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| Format: | Article |
| Language: | English |
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NIHR Journals Library
2016-01-01
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| Series: | Health Technology Assessment |
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| Online Access: | https://doi.org/10.3310/hta20070 |
| _version_ | 1828348386912239616 |
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| author | Suneetha Rachaneni Shanteela McCooty Lee J Middleton Victoria L Parker Jane P Daniels Arri Coomarasamy Tina S Verghese Moji Balogun Ilias Goranitis Pelham Barton Tracy E Roberts Jonathan J Deeks Pallavi Latthe on behalf of the Bladder Ultrasound Study (BUS) Collaborative Group |
| author_facet | Suneetha Rachaneni Shanteela McCooty Lee J Middleton Victoria L Parker Jane P Daniels Arri Coomarasamy Tina S Verghese Moji Balogun Ilias Goranitis Pelham Barton Tracy E Roberts Jonathan J Deeks Pallavi Latthe on behalf of the Bladder Ultrasound Study (BUS) Collaborative Group |
| author_sort | Suneetha Rachaneni |
| collection | DOAJ |
| description | Background: Urodynamics (UDS) has been considered the gold standard test for detrusor overactivity (DO) in women with an overactive bladder (OAB). Bladder ultrasonography to measure bladder wall thickness (BWT) is less invasive and has been proposed as an alternative test. Objectives: To estimate the reliability, reproducibility, accuracy and acceptability of BWT in women with OAB, measured by ultrasonography, in the diagnosis of DO; to explore the role of UDS and its impact on treatment outcomes; and to conduct an economic evaluation of alternative care pathways. Design: A cross-sectional test accuracy study. Setting: 22 UK hospitals. Participants: 687 women with OAB. Methods: BWT was measured using transvaginal ultrasonography, and DO was assessed using UDS, which was performed blind to ultrasonographic findings. Intraobserver and interobserver reproducibility were assessed by repeated measurements from scans in 37 and 57 women, respectively, and by repeated scans in 27 women. Sensitivity and specificity were computed at pre-specified thresholds. The smallest real differences detectable of BWT were estimated using one-way analysis of variance. The pain and acceptability of both tests were evaluated by a questionnaire. Patient symptoms were measured before testing and after 6 and 12 months using the International Consultation on Incontinence modular Questionnaire Overactive Bladder (short form) (ICIQ-OAB) questionnaire and a global impression of improvement elicited at 12 months. Interventions and patient outcomes were analysed according to urodynamic diagnoses and BWT measurements. A decision-analytic model compared the cost-effectiveness of care strategies using UDS, ultrasonography or clinical history, estimating the cost per woman successfully treated and the cost per quality-adjusted life-year (QALY). Results: BWT showed very low sensitivity and specificity at all pre-specified cut-off points, and there was no evidence of discrimination at any threshold (p = 0.25). Extensive sensitivity and subgroup analyses did not alter the interpretation of these findings. The smallest detectable difference in BWT was estimated to be 2 mm. Pain levels following both tests appeared relatively low. The proportion of women who found the test ‘totally acceptable’ was significantly higher with ultrasonography than UDS (81% vs. 56%; p < 0.001). Overall, subsequent treatment was highly associated with urodynamic diagnosis (p < 0.0001). There was no evidence that BWT had any relationship with the global impression of improvement responses at 20 months (p = 0.4). Bladder ultrasonography was more costly and less effective than the other strategies. The incremental cost-effectiveness ratio (ICER) of basing treatment on the primary clinical presentation compared with UDS was £491,500 per woman successfully treated and £60,200 per QALY. Performing a UDS in those women with a clinical history of mixed urinary incontinence had an ICER of £19,500 per woman successfully treated and £12,700 per QALY compared with the provision of urodynamic to all women. For DO cases detected, UDS was the most cost-effective strategy. Conclusion: There was no evidence that BWT had any relationship with DO, regardless of the cut-off point, nor any relationship to symptoms as measured by the ICIQ-OAB. Bladder ultrasonography has no diagnostic or prognostic value as a test in this condition. Furthermore, despite its greater acceptability, BWT measurement was not sufficiently reliable or reproducible. Trial registration: Current Controlled Trials ISRCTN46820623. Funding: This project was funded by the National Institute for Health Research (NIHR) Health Technology Assessment programme and will be published in full in Health Technology Assessment; Vol. 20, No. 7. See the NIHR Journals Library website for further project information. |
| first_indexed | 2024-04-14T00:53:16Z |
| format | Article |
| id | doaj.art-12c889114c1343f992c0c3545475ac3b |
| institution | Directory Open Access Journal |
| issn | 1366-5278 2046-4924 |
| language | English |
| last_indexed | 2024-04-14T00:53:16Z |
| publishDate | 2016-01-01 |
| publisher | NIHR Journals Library |
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| series | Health Technology Assessment |
| spelling | doaj.art-12c889114c1343f992c0c3545475ac3b2022-12-22T02:21:41ZengNIHR Journals LibraryHealth Technology Assessment1366-52782046-49242016-01-0120710.3310/hta2007009/22/122Bladder ultrasonography for diagnosing detrusor overactivity: test accuracy study and economic evaluationSuneetha Rachaneni0Shanteela McCooty1Lee J Middleton2Victoria L Parker3Jane P Daniels4Arri Coomarasamy5Tina S Verghese6Moji Balogun7Ilias Goranitis8Pelham Barton9Tracy E Roberts10Jonathan J Deeks11Pallavi Latthe12on behalf of the Bladder Ultrasound Study (BUS) Collaborative GroupSchool of Clinical and Experimental Medicine, University of Birmingham, Birmingham, UKBirmingham Women’s NHS Foundation Trust, Birmingham, UKBirmingham Clinical Trials Unit, University of Birmingham, Birmingham, UKBirmingham Clinical Trials Unit, University of Birmingham, Birmingham, UKSchool of Clinical and Experimental Medicine, University of Birmingham, Birmingham, UKSchool of Clinical and Experimental Medicine, University of Birmingham, Birmingham, UKSchool of Clinical and Experimental Medicine, University of Birmingham, Birmingham, UKBirmingham Women’s NHS Foundation Trust, Birmingham, UKHealth Economics Unit, University of Birmingham, Birmingham, UKHealth Economics Unit, University of Birmingham, Birmingham, UKHealth Economics Unit, University of Birmingham, Birmingham, UKBirmingham Clinical Trials Unit, University of Birmingham, Birmingham, UKSchool of Clinical and Experimental Medicine, University of Birmingham, Birmingham, UKBackground: Urodynamics (UDS) has been considered the gold standard test for detrusor overactivity (DO) in women with an overactive bladder (OAB). Bladder ultrasonography to measure bladder wall thickness (BWT) is less invasive and has been proposed as an alternative test. Objectives: To estimate the reliability, reproducibility, accuracy and acceptability of BWT in women with OAB, measured by ultrasonography, in the diagnosis of DO; to explore the role of UDS and its impact on treatment outcomes; and to conduct an economic evaluation of alternative care pathways. Design: A cross-sectional test accuracy study. Setting: 22 UK hospitals. Participants: 687 women with OAB. Methods: BWT was measured using transvaginal ultrasonography, and DO was assessed using UDS, which was performed blind to ultrasonographic findings. Intraobserver and interobserver reproducibility were assessed by repeated measurements from scans in 37 and 57 women, respectively, and by repeated scans in 27 women. Sensitivity and specificity were computed at pre-specified thresholds. The smallest real differences detectable of BWT were estimated using one-way analysis of variance. The pain and acceptability of both tests were evaluated by a questionnaire. Patient symptoms were measured before testing and after 6 and 12 months using the International Consultation on Incontinence modular Questionnaire Overactive Bladder (short form) (ICIQ-OAB) questionnaire and a global impression of improvement elicited at 12 months. Interventions and patient outcomes were analysed according to urodynamic diagnoses and BWT measurements. A decision-analytic model compared the cost-effectiveness of care strategies using UDS, ultrasonography or clinical history, estimating the cost per woman successfully treated and the cost per quality-adjusted life-year (QALY). Results: BWT showed very low sensitivity and specificity at all pre-specified cut-off points, and there was no evidence of discrimination at any threshold (p = 0.25). Extensive sensitivity and subgroup analyses did not alter the interpretation of these findings. The smallest detectable difference in BWT was estimated to be 2 mm. Pain levels following both tests appeared relatively low. The proportion of women who found the test ‘totally acceptable’ was significantly higher with ultrasonography than UDS (81% vs. 56%; p < 0.001). Overall, subsequent treatment was highly associated with urodynamic diagnosis (p < 0.0001). There was no evidence that BWT had any relationship with the global impression of improvement responses at 20 months (p = 0.4). Bladder ultrasonography was more costly and less effective than the other strategies. The incremental cost-effectiveness ratio (ICER) of basing treatment on the primary clinical presentation compared with UDS was £491,500 per woman successfully treated and £60,200 per QALY. Performing a UDS in those women with a clinical history of mixed urinary incontinence had an ICER of £19,500 per woman successfully treated and £12,700 per QALY compared with the provision of urodynamic to all women. For DO cases detected, UDS was the most cost-effective strategy. Conclusion: There was no evidence that BWT had any relationship with DO, regardless of the cut-off point, nor any relationship to symptoms as measured by the ICIQ-OAB. Bladder ultrasonography has no diagnostic or prognostic value as a test in this condition. Furthermore, despite its greater acceptability, BWT measurement was not sufficiently reliable or reproducible. Trial registration: Current Controlled Trials ISRCTN46820623. Funding: This project was funded by the National Institute for Health Research (NIHR) Health Technology Assessment programme and will be published in full in Health Technology Assessment; Vol. 20, No. 7. See the NIHR Journals Library website for further project information.https://doi.org/10.3310/hta20070bladder ultrasonographydetrusor overactivitybladder wall thicknesstest accuracy studyeconomic evaluation |
| spellingShingle | Suneetha Rachaneni Shanteela McCooty Lee J Middleton Victoria L Parker Jane P Daniels Arri Coomarasamy Tina S Verghese Moji Balogun Ilias Goranitis Pelham Barton Tracy E Roberts Jonathan J Deeks Pallavi Latthe on behalf of the Bladder Ultrasound Study (BUS) Collaborative Group Bladder ultrasonography for diagnosing detrusor overactivity: test accuracy study and economic evaluation Health Technology Assessment bladder ultrasonography detrusor overactivity bladder wall thickness test accuracy study economic evaluation |
| title | Bladder ultrasonography for diagnosing detrusor overactivity: test accuracy study and economic evaluation |
| title_full | Bladder ultrasonography for diagnosing detrusor overactivity: test accuracy study and economic evaluation |
| title_fullStr | Bladder ultrasonography for diagnosing detrusor overactivity: test accuracy study and economic evaluation |
| title_full_unstemmed | Bladder ultrasonography for diagnosing detrusor overactivity: test accuracy study and economic evaluation |
| title_short | Bladder ultrasonography for diagnosing detrusor overactivity: test accuracy study and economic evaluation |
| title_sort | bladder ultrasonography for diagnosing detrusor overactivity test accuracy study and economic evaluation |
| topic | bladder ultrasonography detrusor overactivity bladder wall thickness test accuracy study economic evaluation |
| url | https://doi.org/10.3310/hta20070 |
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