ABSENCE OF HEDONIC ADAPTATION IN URGE INCONTINENCE
Amber E. Barnato, MD, MPH, MS, Kenneth Smith, MD, MSc, Neil M. Resnick, MD, Lisa J. Rosenberg, MD, and Mark S. Roberts, MD, MPP. University of Pittsburgh School of Medicine, Pittsburgh, PA
Purpose: Hedonic adaptation to chronic health conditions may result in underestimation of the impact and cost-effectiveness of condition mitigation or cure. Elicitation of post-treatment retrospective (hindsight) utilities may reveal larger apparent treatment gains. We sought to assess the magnitude of hedonic adaptation in a common chronic condition, urge incontinence. Methods: We used Impact 3.0 to collect standard gamble (SG) and time-trade off (TTO) health state utilities among women enrolled in a biofeedback clinical trial for urge incontinence. We compared baseline, pre-treatment utility measures to retrospective (hindsight) assessments of pre-treatment utility ascertained 6 months post-treatment, using the Wilcoxon signed-rank test for crude utilities, and, for adjusted utilities, linear regression adjusted for age, duration of incontinence, baseline Urge Impact Scale (URIS), and treatment effectiveness (URIS improvement). Results: 2 subjects clearly misunderstood the SG task, based upon utilities of ~ 0 (compared to TTO utilities ~ 1), and were dropped from the analysis. The mean age of the 21 subjects with pre- and post-treatment utility assessments was 73.7 (SD 7.2) years, and their mean duration of incontinence was 6.4 (5.9) years. The 15 subjects with pre- and post-treatment URIS scores had a statistically and clinically significant response to treatment. In crude comparisons (n=21), hindsight assessments of pre-treatment utility were no different than actual pre-treatment utility using SG (0.81 vs. 0.81, p>0.05) and were higher using TTO (0.97 vs. 0.90, p=0.0005). In adjusted analyses (n=15), hindsight and actual pre-treatment utilities were no different with both SG (0.80 vs. 0.79, p>0.05) and TTO (0.97 vs. 0.89, p>0.05). A greater treatment response was associated with higher hindsight SG pre-treatment utility but not TTO utility. Baseline incontinence severity did not affect SG or TTO utility differences. Conclusions: There is no evidence of hedonic adaptation to urge incontinence, even among women with greater baseline quality-of-life impairment due to their condition. Instead, the data suggest that subjects minimize past disutility, particularly if they have greater functional improvement with treatment. This study is limited by the non-random ascertainment of pre-treatment utility (utility at the time of trial enrollment may not be representative if subjects are motivated to enroll when condition is most troublesome), lack of longer-term follow up, and small sample size.