Technologies for Managing Urinary Incontinence July 1985 NTIS order #PB85-240208 HEALTH TECHNOLOGY CASE STUDY 33 Technologies for Managing Urinary Incontinence JULY 1985 This case study was performed as part of OTA’S assessments: Federal Policies and the Medical Devices Industry and Technology and Aging in America Prepared for OTA by: Joseph Ouslander, M.D. UCLA School of Medicine and Robert Kane, M.D. UCLA School of Medicine with Shira Vollmer UCLA School of Medicine and Melvyn Menezes School of Management, UCLA OTA Case Studies are documents containing information on a specific medical technology or area of application that supplements formal OTA assessments, The material is not normally of as immediate policy interest as that in an OTA Report, nor does it present options for Congress to consider. CONGRESS OF THE UNITED STATES Office of Technology Assessment Washington, D C 20510 Recommended Citation: Ouslander, Joseph, Kane, Robert, Vollmer, Shira, and Menezes, Melvyn, Technologies for Managing Urinary Incontinence (Health Technology Case Study 33), OTA-HCS-33, Washington, DC: U.S. Congress, Office of Technology Assessment, July 1985. This case study was performed as part of OTA’S assessments of Federal Policies and the Medical Devices Industry and Technology and Aging in America. Library of Congress Catalog Card Number 85-600554 For sale by the Superintendent of Documents U.S. Government Printing Office, Washington, DC 20402 Preface Technologies for Managing Urinary Incon- various fields. Selection criteria were developed tinence is Case Study 33 in OTA’S Health Tech- to ensure that case studies provide the following: nology Case Study Series. This case study has ● examples of types of technologies by func- been prepared in connection with two OTA proj- ects: Federal Policies and the Medical Devices In- tion (preventive, diagnostic, therapeutic, and rehabilitative); dustry and Technology and Aging in America. ● The former project, conducted by the Health Pro- examples of types of technologies by physical nature (drugs, devices, and procedures); gram, was requested by the House Committee on ● examples of technologies in different stages Energy and Commerce and its Subcommittee on of development and diffusion (new, emerg- Health and the Environment and the Senate Com- ing, and established); mittee on Finance, Subcommittee on Health. The ● latter project, conducted by the Biological Ap- examples from different areas of medicine plications Program, was requested by the House (e.g., general medical practice, pediatrics, radiology, and surgery); Select Committee on Aging, and the Senate ● examples addressing medical problems that Special Committee on Aging. A listing of other are important because of their high frequen- case studies in the series is included at the end of cy or significant impacts (e. g., cost); this preface, and endorsed by the House Commit- ● examples of technologies with associated high tee on Education and Labor. costs either because of high volume (for low- OTA case studies are designed to fulfill two cost technologies) or high individual costs; functions. The primary purpose is to provide ● examples that could provide information ma- OTA with specific information that can be used terial relating to the broader policy and meth- in forming general conclusions regarding broader odological issues being examined in the policy issues. The first 19 cases in the Health Tech- particular overall project; and nology Case Study Series, for example, were con- ● examples with sufficient scientific literature. ducted in conjunction with OTA’S overall project Case studies are either prepared by OTA staff, The Implications of Cost-Effectiveness Anal- on commissioned by OTA and performed under con- ysis of Medical Technology. By examining the 19 tract by experts (generally in academia), or writ- cases as a group and looking for common prob- ten by OTA staff on the basis of contractors’ lems or strengths in the techniques of cost-effec- papers. tiveness or cost-benefit analysis, OTA was able to better analyze the potential contribution that OTA subjects each case study to an extensive those techniques might make to the management review process. Initial drafts of cases are reviewed of medical technology and health care costs and by OTA staff and by members of the advisory quality. panel to the associated project. For commissioned cases, comments are provided to authors, along The second function of the case studies is to with OTA’S suggestions for revisions. Subsequent provide useful information on the specific tech- drafts are sent by OTA to numerous experts for nologies covered. The design and the funding lev- review and comment. Each case is seen by at least els of most of the case studies are such that they 30 reviewers, and sometimes by 80 or more out- should be read primarily in the context of the as- side reviewers. These individuals may be from sociated overall OTA projects. Nevertheless, in relevant Government agencies, professional so- many instances, the case studies do represent ex- cieties, consumer and public interest groups, med- tensive reviews of the literature on the efficacy, ical practice, and academic medicine. Academi- safety, and costs of the specific technologies and cians such as economists, sociologists, decision as such can stand on their own as a useful contri- analysts, biologists, and so forth, as appropriate, bution to the field. also review the cases. Case studies are prepared in some instances be- Although cases are not statements of official cause they have been specifically requested by OTA position, the review process is designed to congressional committees and in others because satisfy OTA’S concern with each case study’s they have been selected through an extensive re- scientific quality and objectivity. During the vari- view process involving OTA staff and consulta- ous stages of the review and revision process, tions with the congressional staffs, advisory panel therefore, OTA encourages, and to the extent to the associated overall project, the Health Pro- possible requires, authors to present balanced in- gram Advisory Committee, and other experts in formation and recognize divergent points of view. 111 Health Technology Case Study Seriesa Case Study Case study title; author(s); Case Study Case study title; author(s); Series No. OTA publication numberb Series No. OTA publication numberb 1 Formal Analysis, Policy Formulation, and End-Stage Renal 18 The Efficacy and Cost Effectiveness of Psychotherapy; Disease; Leonard Saxe (Office of Technology Assessment) Richard A. Rettig (OTA-BP-H-9(1))C (OTA-BP-H-9(18)) d 2 The Feasibility of Economic Evaluation of Diagnostic Pro- 19 Assessment of Four Common X-Ray Procedures; cedures: The Case of CT Scanning; Judith L. Wagner (OTA-BP-H-9(19))e Judith L. Wagner (OTA-BP-H-9(2)) 20 Mandatory Passive Restraint Systems in Automobiles: Issues 3 Screening for Colon Cancer: A Technology Assessment; and Evidence; David M. Eddy (OTA-BP-H-9(3)) Kenneth E. Warner (OTA-BP-H-15(20))f 4 Cost Effectiveness of Automated Multichannel Chemistry 21 Selected Telecommunications Devices for Hearing-Impaired Analyzers; Persons; Milton C. Weinstein and Laurie A. Pearlman Virginia W. Stern and Martha Ross Redden (OTA-BP-H-9(4)) (OTA-BP-H-16(21)) g 5 Periodontal Disease: Assessing the Effectiveness and Costs of 22 The Effectiveness and Costs of Alcoholism Treatment; the Keyes Technique; Leonard Saxe, Denise Dougherty, Katharine Esty, Richard M. Scheffler and Sheldon Rovin and Michelle Fine (OTA-HCS-22) (OTA-BP-H-9(5)) 23 The Safety, Efficacy, and Cost Effectiveness of Therapeutic 6 The Cost Effectiveness of Bone Marrow Transplant Therapy Apheresis; and Its Policy Implications; John C. Langenbrunner (Office of Technology Assessment) Stuart O. Schweitzer and C. C. Scalzi (OTA-BP-H-9(6)) (OTA-HCS-23) 7 Allocating Costs and Benefits in Disease Prevention Programs: 24 Variation in Length of Hospital Stay: Their Relationship to An Application to Cervical Cancer Screening; Health Outcomes; Bryan R. Luce (Office of Technology Assessment) Mark R. Chassin (OTA-HCS-24) (OTA-BP-H-9(7)) 25 Technology and Learning Disabilities; 8 The Cost Effectiveness of Upper Gastrointestinal Endoscopy; Candis Cousins and Leonard Duhl (OTA-HCS-25) Jonathan A. Showstack and Steven A. Schroeder 26 Assistive Devices for Severe Speech Impairments; (OTA-Bp-H-9(8)) Judith Randal (Office of Technology Assessment) 9 The Artificial Heart: Cost, Risks, and Benefits; (OTA-HCS-26) Deborah P. Lubeck and John P. Bunker 27 Nuclear Magnetic Resonance Imaging Technology: A Clinical, (OTA-BP-H-9(9)) Industrial, and Policy Analysis; 10 The Costs and Effectiveness of Neonatal Intensive Care; Earl P. Steinberg and Alan Cohen (OTA-HCS-27) Peter Budetti, Peggy McManus, Nancy Barrand, and 28 Intensive Care Units (ICUs): Clinical Outcomes, Costs, and Lu Ann Heinen (OTA-BP-H-9(1O)) Decisionmaking; 11 Benefit and Cost Analysis of Medical Interventions: The Case Robert A. Berenson (OTA-HCS-28) of Cimetidine and Peptic Ulcer Disease; 29 The Boston Elbow; Harvey V. Fineberg and Laurie A. Pearlman Sandra J. Tanenbaum (OTA-HCS-29) (OTA-BP-H-9(I1)) 30 The Market for Wheelchairs: Innovations and Federal Policy; 12 Assessing Selected Respiratory Therapy Modalities: Trends and Donald S. Shepard and Sarita L. Karen (OTA-HCS-30) Relative Costs in the Washington, D.C. Area; 31 The Contact Lens Industry: Structure, Competition, and Public Richard M. Scheffler and Morgan Delaney Policy; (OTA-BP-H-9(12)) Leonard G. Schifrin and William J. Rich (OTA-HCS-31) 13 Cardiac Radionuclide Imaging and Cost Effectiveness; 32 The Hemodialysis Equipment and Disposable Industry; William B. Stason and Eric Fortess (OTA-BP-H-9(13)) Anthony A. Romeo (OTA-HCS-32) 14 Cost Benefit/Cost Effectiveness of Medical Technologies: A 33 Technologies for Managing Urinary Incontinence; Case Study of Orthopedic Joint Implants; Joseph Ouslander, Robert Kane, Shira Vollmer, and Melvyn Judith D. Bentkover and Philip G. Drew (OTA-BP-H-9(14)) Menezes (OTA-HCS-33) 15 Elective Hysterectomy: Costs, Risks, and Benefits; 34 The Cost Effectiveness of Digital Subtraction Angiography in Carol Korenbrot, Ann B.