Patient preferences for stress urinary incontinence treatments: a discrete choice experiment

Dwayne Boyers* (Corresponding Author), Mary Kilonzo, Tracey Davidson, David Cooper, Judith Wardle, Kiron Bhal, James N’Dow, Graeme MacLennan, John Norrie, Mohamed Abdel-Fattah

*Corresponding author for this work

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To elicit and value patient preferences for the processes and outcomes of surgical management of stress urinary incontinence in women.
Design: A discrete choice experiment survey to elicit preferences for type of anaesthesia, post-op time, treatment success, adverse events, impact on daily activities and cost. An experimental design generated 40 choice tasks, and each respondent completed one block of 10 and two validity tests. Analysis was by multinomial logistical regression.
Setting: N=21 UK hospitals
Participants: N=325 adult women who were a sub-sample of those randomised to the SIMS clinical trial.
Outcomes: Patient preferences; valuation obtained using willingness to pay
N=227/325 (70%) returned a questionnaire, and 94% of those completed all choice tasks. Respondents preferred general anaesthesia, shorter recovery times, improved stress urinary incontinence symptoms and avoidance of adverse events. Women were willing to pay, mean (95% CI), £76(£33 to £119) per day of reduction in recovery time following surgery. They valued increases in Patient Global Impression of Improvement, ranging from £8,173 (£5,459
to £10,887) for “improved” to £11,706 (£8,267 to £15,144) for “very much improved”, compared to no improvement. This was offset by negative values attached to complications ranging between £-8,022 (£-10,661 to £-5,383) and £-10,632 (£-14,077 to £-7,187) for the avoidance of various complications. Avoidance of daily activities had a negative impact on preferences, with willingness to pay ranging from £-967 (£-2,199 to £266) for rarely avoiding
activities to £-5,338 (£-7258 to £-3417) for frequently avoiding daily activities compared to no avoidance.
Conclusion: This discrete choice experiment demonstrates that patients place considerable value on improvement in stress urinary incontinence symptoms and avoidance of treatment complications. These trade-offs should be considered within shared decision making. The willingness to pay values from this study can be used in future cost-benefit analyses.
Original languageEnglish
Article numbere066157
Pages (from-to)e066157
Number of pages27
JournalBMJ Open
Issue number8
Early online date29 Aug 2023
Publication statusPublished - 29 Aug 2023

Bibliographical note

The study was funded by the National Institute for Health Research (NIHR) Health Technology Assessment Programme (project number: 12/127/157). The full project report is available from the funder’s website: The full citation for the funder report is: Abdel-Fattah M, Cooper D, Davidson T, Kilonzo M, Boyers D, Bhal K, et al. Single-incision mini-slings versus standard synthetic mid-urethral slings for surgical treatment of stress urinary incontinence in women: The SIMS RCT. Health Technol Assess 2022;26(47). The Health Economics Research Unit and Health Services Research Unit are both funded by the Chief Scientist’s Office (CSO) of the Scottish government health directorates. The SIMS trial was registered as: ISRCTN93264234.

Data Availability Statement

Data are available upon reasonable request. Data are available upon reasonable request by contacting the corresponding author.


  • Surgery
  • Urinary Incontinence
  • Health policy
  • Health Economics
  • Patient preference


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