Evaluation of MUTU® System

Context

Over one third of post-partum women experience long-term post-partum conditions (Vogel et al., 2023) such as pelvic organ prolapse (POP), urinary incontinence (UI), and dyspareunia (painful sex).

Pelvic health issues for women in their post-partum period currently represents an unmet healthcare need; many women with symptoms do not present to the NHS and receive treatment, which can lower their quality of life.

MUTU^® System is an online programme that provides pelvic floor muscle training and learning materials designed to improve pelvic health symptoms.

Method

Post-partum mothers displaying symptoms of POP or UI were referred to MUTU^® System through the following pathways:

A self-pay cohort was also included in the evaluation, consisting of mothers who paid to use MUTU^® System. This cohort showed similarities with the NHS cohorts in terms of age and perinatal stage, however had a much larger sample size (N = 8,467). These patients completed a baseline survey, then a survey at 3, 6, and 12 weeks of using MUTU^® System.

GPs and physiotherapy staff were invited to complete a staff experience and a patient experience survey to uncover any further staff feedback around user acceptance and staff satisfaction of MUTU^® System.

Qualitative insights

Patient surveys identified the following after patients had used MUTU^® System for 12 weeks:

Staff surveys highlighted the importance of ensuring mothers are aware of MUTU^® System in the antenatal stage so they know they can receive treatment for their symptoms. It was also suggested that MUTU^® System should be implemented within GP practice settings, rather than physiotherapy settings, reducing the number of contacts required to receive treatment.

Quantitative insights

Qualitative survey responses were coded into quantitative data. A paired t-test was conducted to determine whether there was a significant improvement in symptoms after using MUTU^® System. Figure 1 highlights an improvement in symptom prevalence in the non-NHS cohort for POP, UI, and dyspareunia.

Figure 1: Percentage improvement in level of concern following MUTU^® System in the non-NHS cohort.

MUTU^® System leads to a statistically significant reduction in symptom prevalence for POP, UI, dyspareunia, diastasis recti, back pain, mental health, and body fat concerns in the self-pay cohort (p < 0.05). As the self-pay cohort shared similar demographic proportions to the NHS cohorts, it is likely that there was a statistically significant reduction in symptom prevalence for the NHS cohorts too.

Health economic modelling

The net benefit and net present value (NPV) that may be realised due to MUTU^® System for three distinct scenarios were identified in the following benefit streams:

Cash releasing:

• Reduction in urinary incontinence treatment costs due to MUTU^® System
• Reduction in pelvic organ prolapse costs due to MUTU^® System
• Reduction in dyspareunia treatment costs due to MUTU^® System

Non-cash releasing:

• Improvement in quality of life due to using MUTU^® System to manage symptoms of pelvic organ prolapse
• Improvement in quality of life due to using MUTU^® System to manage symptoms of urinary incontinence

The findings from the cost-benefit analysis when pricing MUTU^® System at £50 per NHS programme user was as follows:

To be cost-neutral, MUTU^® System must be priced at £44 per NHS user or lower. Sensitivity analysis identified that a variation to the prevalence of dyspareunia had the greatest effect on the mean NPV in scenarios 2 and 3. Similarly, the prevalence of UI and POP were also influential factors, in addition to engagement with MUTU^® System. This means that MUTU^® System is more likely to identify cost-saving benefits from using MUTU^® System for mothers with POP and UI symptoms.

Limitations

The current evaluation posed the following limitations:

• Staff and patient surveys yielded small sample sizes, meaning that insights gained were limited and may differ to the wider sample of NHS staff and patients.
• The GP practice cohort survey had a lack of baseline due to question errors, meaning a lack of insight.
• The small sample size for the physiotherapy and GP practice cohorts meant that understanding quantitative symptom improvement over time was limited; few participants responded to all four surveys. To mitigate this, the self-pay cohort was used as all cohorts shared similar user demographics.
• Availability of accurate treatment costs for pelvic health symptoms was limited. Reliance on total annual treatment costs resulted in high optimism bias to account for the uncertain accuracy.

Recommendations

The following recommendations were suggested as a result of the evaluation:

Conclusion

Overall, MUTU^® System has the potential to provide a cost-effective and appropriate treatment method for NHS patients experiencing mild and moderate UI and POP symptoms. The programme could be utilised to provide support for women when recovering from birth through improving access to post-partum physiotherapy, ultimately addressing this currently unmet health need.