Arabian Gulf University - Manama, Kingdom of Bahrain
Although not a life threatening condition, urinary incontinence (UI) is a prevalent, distressing and disabling condition which causes significant physical and psychological morbidity in individuals of all ages. Sufferers give up many aspects of their usual life with obvious detriment to their social interactions, interpersonal and sexual relationships, careers and emotional well-being.
UI imposes an undeniable financial burden upon those with the condition and on society as a whole. In a seminal article by Wagner and T-w in 1998, the economic costs of UI in the United States in 1995 totaled $ 26.3 billion, or $ 3,565 per individual aged 65 and older with the condition in a seminal article published by . Whether one is a health practitioner or a policy maker, this is a staggering amount.
To understand how this total was calculated, first it is important to understand that there are costs associated with UI whether the person is treated or not. If a person is afraid to seek medical attention, then diagnostic and treatment costs will be zero. However, costs are incurred when UI goes untreated. These include routine care costs ( e.g. disposable garments and laundry), consequence costs such as treating urinary tract infections and admissions to nursing home or hospital, indirect costs i.e. lost productivity and intangible costs i.e. pain, stress and suffering. Likewise, if the person is treated and becomes continent, treatment costs are incurred but the routine, consequence, indirect and intangible costs are mitigated. It is noteworthy that in cost-benefit analysis like most studies in the medical literature, the treatment costs are compared to monetary savings from reduced routine care costs, consequence costs, indirect costs and intangible costs. In contrast, this article only describes the total economic burden imposed by UI.
Of the $ 26.3 billion mentioned in this article  , 48 % ($12.5 billion) of these resources were drawn directly from the economy to diagnose, treat, care for and rehabilitate patients with UI. These resources can be further categorized into diagnostic, treatment and routine care costs. In sum, these costs have been relatively well studied over the past decade and they are expected to have increased by three-fold between 1995 and 2015, owing partly to increase in the cost of medical care and routine care and partly to a growing population of older adults.
The costs associated with consequences of UI are harder to quantify. Whereas the medical community is aware that UI can lead to urinary tract infections, skin irritation and admission to a nursing home or a hospital, it is harder to identify what fraction of these costs should be attributed to the incontinence itself. In 1995, these costs were estimated at $ 13.1 billion in the United States, but this should be viewed as an approximation rather than an actual figure . Together, the diagnostic, treatment , routine care and consequence costs are estimated at $ 25.6 billion and the indirect costs, which are the value of lost earnings at $ 704 million. Not included in the total value of cost is the monetary value of pain, stress, and suffering. Hence, even though this total cost is large, it is conservative.
For Mediterranean countries, there are several important factors to envisage in future economic studies of UI such as :
1) The costs of UI among younger age groups including children.
2) Detailed estimates of the consequence costs and the indirect costs.
3) The costs associated with less well studied categories of UI such as urge, overflow and mixed incontinence.
4) The cost-effectiveness of treating UI when its etiology is a treatment of another illness (e.g. prostate cancer surgery) or is another condition (e.g. diabetic autonomic neuropathy).
5) The cost-effectiveness of new and existing behavioral, medical and surgical treatments.
6) The effect of the health care system on access, quality and costs of UI.
Our ability to address many of these topics is hampered by a paucity of relevant data. For example, there are no ICD-9 codes for urge or overflow incontinence, as there is for stress incontinence. Furthermore, the use of administrative data to study costs is undermined by the different methods available for capitated payments. These hurdles are not insurmountable and advances can be made with collaboration, persistence and some ingenuity of the medical and economic professions.
1. Wagner TH, Hu T-w. Economic costs of urinary incontinence in 1995. Urology 1998; 51: 355-361
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