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Costs of Urinary Incontinence and Overactive Bladder in the United States: A Comparative Study
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VOIDING FUNCTION, BLADDER PHYSIOLOGY AND PHARMACOLOGY, AND FEMALE UROLOGY
Costs of Urinary Incontinence and Overactive Bladder in the United States: A Comparative Study T.-W. HU, T. H. WAGNER, J. D. BENTKOVER, K. LEBLANC, S. Z. ZHOU AND T. HUNT, Department of Health Economics, University of California, Berkeley, School of Public Health, Berkeley, and Department of Veterans Affairs and Stanford University School of Medicine, Stanford, California, Innovative Health Solutions, Brookline, Massachusetts, and Pharmacia Corporation, Peapack, New Jersey Urology, 63: 461– 465, 2004 Objectives. To update the cost of urinary incontinence (UI) for year 2000 and compare it with the cost of overactive bladder (OAB). Methods. Using the cost-of-illness framework, disease epidemiologic data were combined with treatment rates, consequence probabilities, and average cost estimates. All costs reflect the costs during 2000. Results. The total cost of UI and OAB was $19.5 billion and $12.6 billion, respectively (year 2000 dollars). With UI, $14.2 billion was borne by community residents and $5.3 billion by institutional residents. With OAB, $9.1 and $3.5 billion, respectively, was incurred by community and institutional residents. Conclusions. OAB affected 34 million individuals compared with 17 million with UI. Despite the differences in epidemiology, the total and per-person costs of UI were higher than the OAB costs because OAB individuals without incontinent episodes incurred fewer costs, on average. Editorial Comment: This is another detailed analysis by Hu et al. Aside from the figures themselves, there are 2 interesting facts that should be noted with respect to this article. A previous study by Wagner and Hu1 estimated the cost of urinary incontinence at 26.3 billion dollars in 1995 dollars. The current figure represents a 26% decrease. Four factors, detailed in the article and too lengthy to reproduce here, are used to explain this. The bottom line seems to be that some of the assumptions regarding the previous estimate were incorrect. The second issue is that the estimated number of people with overactive bladder in the United States was 34 million, approximately what would be expected on the basis of estimates from the National Overactive Bladder Evaluation.2 However, only 2.9 million of these people, or 8.5%, were classified as OAB wet (having incontinence episodes). This differs from the 37% figure reported in the National Overactive Bladder Evaluation. There is no explanation offered for the discrepancy. This colossal difference in prevalence, and the presumably greater costs of caring for OAB wet as opposed to OAB dry, raises questions regarding the accuracy of these estimates, which doubtless will be used in the preamble to many grant applications and journal submissions. Additionally, it would have been interesting to calculate the costs of OAB wet versus OAB dry. Alan J. Wein, M.D. 1. Wagner, T. H. and Hu, T. W.: Economic costs of urinary incontinence in 1995. Urology, 51: 355, 1998 2. Stewart, W. F., Van Rooyen, J. B., Cundiff, G. W., Abrams, P., Herzog, A. R., Corey, R. et al: Prevalence and burden of overactive bladder in the United States. World J Urol, 20: 327, 2003
Prediction of Genitourinary Tract Morbidity After Brachytherapy for Prostate Adenocarcinoma M. J. WEHLE, S. W. LISSON, S. J. BUSKIRK, G. A. BRODERICK, P. R. YOUNG AND T. C. IGEL, Departments of Urology and Radiation Oncology, Mayo Clinic College of Medicine, Jacksonville, Florida Mayo Clin Proc, 79: 314 –317, 2004 Objective: To investigate whether preoperative genitourinary variables in patients undergoing brachytherapy for localized prostate adenocarcinoma could predict postoperative genitourinary tract morbidity. Patients and Methods: We retrospectively reviewed medical records of 105 men who received either iodine 125 or palladium 103 radioactive seed implants with or without external beam radiotherapy or hormone blockade from January 1, 1998, through December 31, 2000, at the Mayo Clinic in Jacksonville, Fla. Patients with one or more of the following were classified as having a high risk of postoperative genitourinary tract morbidity: American Urological Association symptom scores greater than 15, maximum urinary flow rate less than 10 mL/s, postvoid residual urinary volume greater than 100 mL, or prostate volume greater than 40 cm3. Of the 105 men, 59 (56%) were classified as high risk and 46 (44%) as low risk. Mean follow-up after brachytherapy was 23.6 months. Modified Radiation Therapy Oncology Group scores were used to assess postoperative genitourinary tract morbidity. The term significant genitourinary tract morbidity was applied to patients with a Radiation Therapy Oncology Group grade of 3 or 4 after at least 6 months of follow-up. Results: Significant morbidity occurred in 37% of high-risk vs 15% of low-risk patients (P ⫽ .006). In high-risk patients, transurethral resection or incision of the prostate was required in 5 patients, urethral dilation in 4, direct-vision internal urethrotomy in 1, and placement of a suprapubic catheter in 1. In low-risk patients, transurethral incision of the prostate was required in only 1 patient. Urinary flow rate was a significant individual predictor of postoperative morbidity (P ⫽ .03). Conclusions: A combination of urinary flow rate, prostate volume, postvoid residual urinary volume, and American Urological Association symptom score can help identify patients with underlying voiding dysfunction. Urinary flow rate was a statistically significant predictor of genitourinary tract morbidity after
VOIDING FUNCTION, BLADDER PHYSIOLOGY AND PHARMACOLOGY, AND FEMALE UROLOGY
Costs of Urinary Incontinence and Overactive Bladder in the United States: A Comparative Study T.-W. HU, T. H. WAGNER, J. D. BENTKOVER, K. LEBLANC, S. Z. ZHOU AND T. HUNT, Department of Health Economics, University of California, Berkeley, School of Public Health, Berkeley, and Department of Veterans Affairs and Stanford University School of Medicine, Stanford, California, Innovative Health Solutions, Brookline, Massachusetts, and Pharmacia Corporation, Peapack, New Jersey Urology, 63: 461– 465, 2004 Objectives. To update the cost of urinary incontinence (UI) for year 2000 and compare it with the cost of overactive bladder (OAB). Methods. Using the cost-of-illness framework, disease epidemiologic data were combined with treatment rates, consequence probabilities, and average cost estimates. All costs reflect the costs during 2000. Results. The total cost of UI and OAB was $19.5 billion and $12.6 billion, respectively (year 2000 dollars). With UI, $14.2 billion was borne by community residents and $5.3 billion by institutional residents. With OAB, $9.1 and $3.5 billion, respectively, was incurred by community and institutional residents. Conclusions. OAB affected 34 million individuals compared with 17 million with UI. Despite the differences in epidemiology, the total and per-person costs of UI were higher than the OAB costs because OAB individuals without incontinent episodes incurred fewer costs, on average. Editorial Comment: This is another detailed analysis by Hu et al. Aside from the figures themselves, there are 2 interesting facts that should be noted with respect to this article. A previous study by Wagner and Hu1 estimated the cost of urinary incontinence at 26.3 billion dollars in 1995 dollars. The current figure represents a 26% decrease. Four factors, detailed in the article and too lengthy to reproduce here, are used to explain this. The bottom line seems to be that some of the assumptions regarding the previous estimate were incorrect. The second issue is that the estimated number of people with overactive bladder in the United States was 34 million, approximately what would be expected on the basis of estimates from the National Overactive Bladder Evaluation.2 However, only 2.9 million of these people, or 8.5%, were classified as OAB wet (having incontinence episodes). This differs from the 37% figure reported in the National Overactive Bladder Evaluation. There is no explanation offered for the discrepancy. This colossal difference in prevalence, and the presumably greater costs of caring for OAB wet as opposed to OAB dry, raises questions regarding the accuracy of these estimates, which doubtless will be used in the preamble to many grant applications and journal submissions. Additionally, it would have been interesting to calculate the costs of OAB wet versus OAB dry. Alan J. Wein, M.D. 1. Wagner, T. H. and Hu, T. W.: Economic costs of urinary incontinence in 1995. Urology, 51: 355, 1998 2. Stewart, W. F., Van Rooyen, J. B., Cundiff, G. W., Abrams, P., Herzog, A. R., Corey, R. et al: Prevalence and burden of overactive bladder in the United States. World J Urol, 20: 327, 2003
Prediction of Genitourinary Tract Morbidity After Brachytherapy for Prostate Adenocarcinoma M. J. WEHLE, S. W. LISSON, S. J. BUSKIRK, G. A. BRODERICK, P. R. YOUNG AND T. C. IGEL, Departments of Urology and Radiation Oncology, Mayo Clinic College of Medicine, Jacksonville, Florida Mayo Clin Proc, 79: 314 –317, 2004 Objective: To investigate whether preoperative genitourinary variables in patients undergoing brachytherapy for localized prostate adenocarcinoma could predict postoperative genitourinary tract morbidity. Patients and Methods: We retrospectively reviewed medical records of 105 men who received either iodine 125 or palladium 103 radioactive seed implants with or without external beam radiotherapy or hormone blockade from January 1, 1998, through December 31, 2000, at the Mayo Clinic in Jacksonville, Fla. Patients with one or more of the following were classified as having a high risk of postoperative genitourinary tract morbidity: American Urological Association symptom scores greater than 15, maximum urinary flow rate less than 10 mL/s, postvoid residual urinary volume greater than 100 mL, or prostate volume greater than 40 cm3. Of the 105 men, 59 (56%) were classified as high risk and 46 (44%) as low risk. Mean follow-up after brachytherapy was 23.6 months. Modified Radiation Therapy Oncology Group scores were used to assess postoperative genitourinary tract morbidity. The term significant genitourinary tract morbidity was applied to patients with a Radiation Therapy Oncology Group grade of 3 or 4 after at least 6 months of follow-up. Results: Significant morbidity occurred in 37% of high-risk vs 15% of low-risk patients (P ⫽ .006). In high-risk patients, transurethral resection or incision of the prostate was required in 5 patients, urethral dilation in 4, direct-vision internal urethrotomy in 1, and placement of a suprapubic catheter in 1. In low-risk patients, transurethral incision of the prostate was required in only 1 patient. Urinary flow rate was a significant individual predictor of postoperative morbidity (P ⫽ .03). Conclusions: A combination of urinary flow rate, prostate volume, postvoid residual urinary volume, and American Urological Association symptom score can help identify patients with underlying voiding dysfunction. Urinary flow rate was a statistically significant predictor of genitourinary tract morbidity after