Abstract
The aim of this study was to evaluate direct expenditures associated with urinary incontinence and overall medical expenditures incurred by women diagnosed with stress urinary incontinence (SUI). The study design was a retrospective analysis of administrative claims data. We identified women with a diagnosis of SUI and no stress, urge or mixed urinary incontinence in the preceding 12 months using the MarketScan 1996–1999 databases. Total expenditures, as well as urinary incontinence-related expenditures, were summarized during the 12 months before and after the initial SUI diagnosis. We also compared expenditures for SUI patients receiving surgical treatment to expenditures for those who did not. There were 8126 patients who met the eligibility criteria. Total healthcare expenditures in the year prior to the initial SUI diagnosis were approximately half of those in the year following the initial diagnosis ($4478 vs $9147). For the subset of patients treated with surgery there was a threefold increase ($4575 vs $14129) in costs. A sensitivity analysis in patients with no comorbid urinary diagnoses found somewhat lower costs but a similar rate of increase in costs between the pre-period and the study period ($3884 vs $7075). Among women with no comorbid urinary diagnoses, approximately 11% ($769; SD $1180) of total mean regression-adjusted annual expenditures ($6892; SD $5067) was attributable to UI. Predicted total expenditures for surgery patients without comorbid urinary diagnoses were $13 212 (SD $7967), 28% of which ($3640;SD $681) were for UI-related costs. We concluded that after diagnosis, annual expenditures for patients were roughly twice those in the year prior to diagnosis. Multivariate analysis suggests that in the year after SUI diagnosis, UI treatment costs represented approximately 10% of total expenditures for all SUI patients, and 26%–28% of total expenditures for the subset of surgically treated patients.
Similar content being viewed by others
Abbreviations
- SUI:
-
Stress urinary incontinence
- UI:
-
Urinary incontinence
References
Hampel C, Wienhold E, Benken N, Eggersmann C, Thuroff JW (1997) Definition of overactive bladder and epidemiology of urinary incontinence. Urology 50(Suppl 6A):4–14
Hunskaar S, Vinsnes RN (1991) The quality of life in women with urinary incontinence as measured by the Sickness Impact Profile. J Am Geriatr Soc 39:378–382
Hagglund D, Walker-Engstrom ML, Larsson G, Leppert J (2001) Quality of life and seeking help in women with urinary incontinence. Acta Obstet Gynecol Scand 80:1051–1055
Grimby A, Milsom I, Molander U, Wiklund I, Ekelund P (1993) The influence of urinary incontinence on the quality of life of elderly women. Age Ageing 22:82–89
Bogner HR, Gallo JJ, Sammel MD et al. (2002) Urinary incontinence and psychological distress in community-dwelling older adults. J Am Geriatr Soc 50:489–495
Wilson L, Brown JS, Shin GP, Luc KO, Subak LL (2001) Annual direct cost of urinary incontinence. Obstet Gynecol 98:398–406
Abrams P, Cardozo L, Fall M et al. (2002) The standardization of terminology of lower urinary tract function: report from the standardization sub-committee of the International Continence Society. Neurourol Urodyn 21:167–178
Hu TW (1990) Impact of urinary incontinence on health-care costs. J Am Geriatr Soc 38:292–295
Wagner TH, Hu TW (1998) Economic costs of urinary incontinence in 1995. Urology 51:355–361
Day PL (2000) Findings of a three-year retrospective study to investigate the prevalence and incidence of urinary incontinence and overactive bladder in a typical managed care setting. Pharm Pract Mgt Q 20:1–11
Kobelt G, Jonsson L, Mattiasson A (1998) Cost-effectiveness of new treatments for overactive bladder: the example of tolterodine, a new muscarinic agent: a markov model. NeurourolUrodyn 17:599–611
Kobelt G (1997) Economic considerations and outcome measurement in urge incontinence. Urology 50(Suppl 6A):100–107
Hall JA, Nelson MA, Meyer JW, Williamson T, Wagner S (2001) Costs and resources associated with the treatment of overactive bladder using retrospective medical care claims data. Manag Care Interface 14:69–75
Ramsey SD, Wagner TH, Bavendam TG (1996) Estimated costs of treating stress urinary incontinence in elderly women according to the AHCPR clinical practice guidelines. Am J Man Care 2:147–154
D’Hoore W, Bouckaert A, Tilquin C (1996) Practical considerations on the use of the Charlson comorbidity index with administrative databases. J Clin Epidemiol 49:1429–1433
Manning WG, Newhouse JP, Duan N et al. (1987) Health insurance and the demand for medical care: evidence from a randomized experiment. Am Econ Rev 77:251–277
Duan N, Manning W, Morris C, Newhouse J (1983) A comparison of alternative models for the demand for medical care. J Bus Econ Stat 2:115–126
Duan N (1983) Smearing estimate: a nonparametric retransformation method. Am Stat Assoc 78:605–610
Manning WG, Mullahy J (2001) Estimating log models: To transform or not to transform? J Health Econ 20:461–494
Brown JS, Waetjen LE, Subak LL et al. (2002) Pelvic organ prolapse surgery in the United States, 1997. Am J Obstet Gynecol 186:712–716
Hay-Smith J, Herbison P, Ellis G, Moore K (2002) Anticholinergic drugs versus placebo for overactive bladder syndrome in adults (Cochrane Review). In: The Cochrane Library, Issue 3, Update Software
Fantl JA, Newman DK, Colling J et al. (1996) Urinary Incontinence in Adults Guideline Update Panel Urinary Incontinence in Adults: Acute and Chronic Management: Clinical Practice Guideline Number 2 (1996 Update). Rockville, Md: Agency for Health Care Policy Research, Public Health Service, US Department of Health and Human Services, Agency for Health Care Policy and Research publication 96–0682
Langa KM, Fultz NH, Saint S, Kabeto MU, Herzog AR (2002) Informal caregiving time and costs for urinary incontinence in older individuals in the United States. J Am Geriatr Soc 50:733–737
Burgio KL, Matthews KA, Engel BT (1991) Prevalence, incidence and correlates of urinary incontinence in healthy middle-aged women. J Urol 146:1255–1259
Shaw C, Jackson C, Hyde C, Allan R (2001) Barriers to help seeking in people with urinary symptoms. Fam Pract 18:48–52
Author information
Authors and Affiliations
Corresponding author
Additional information
Editorial Comment: This paper addresses the costs related specifically to a new diagnosis of stress incontinence. The authors take a different approach from that of other cost studies, in that they exclude women with pre-existing diagnoses of incontinence, focus just on stress incontinence, and provide specific data about each compartment of direct cost. One strength of the design is its longitudinal follow-up by clearly identifying a population of women newly diagnosed with SUI and looking at the costs incurred for at least the following 12 months. A potential limitation is the instability of the population. More studies analyzing direct and indirect costs associated with incontinence are needed.
Rights and permissions
About this article
Cite this article
Kinchen, K.S., Long, S., Orsini, L. et al. A retrospective claims analysis of the direct costs of stress urinary incontinence. Int Urogynecol J 14, 403–411 (2003). https://doi.org/10.1007/s00192-003-1096-6
Received:
Accepted:
Published:
Issue Date:
DOI: https://doi.org/10.1007/s00192-003-1096-6