The "costs" of urinary incontinence for women

Abstract

Objective: To estimate costs of routine care for female urinary incontinence, health-related quality of life, and willingness to pay for incontinence improvement.

Methods: In a cross-sectional study at 5 U.S. sites, 293 incontinent women quantified supplies, laundry, and dry cleaning specifically for incontinence. Costs were calculated by multiplying resources used by national resource costs and presented in 2005 United States dollars (2005). Health-related quality of life was estimated with the Health Utilities Index. Participants estimated willingness to pay for 25-100% improvement in incontinence. Potential predictors of these outcomes were examined using multivariable linear regression.

Results: Mean age was 56 +/- 11 years; participants were racially diverse and had a broad range of incontinence severity. Nearly 90% reported incontinence-related costs. Median weekly cost (25%, 75% interquartile range) increased from 0.37 dollars (0, 4 dollars) for slight to 10.98 dollars (4, 21 dollars) for very severe incontinence. Costs increased with incontinence severity (P < .001). Costs were 2.4-fold higher for African American compared with white women (P < .001) and 65% higher for women with urge compared with those having stress incontinence (P < .001). More frequent incontinence was associated with lower Health Utilities Index score (mean 0.90 +/- 0.11 for weekly and 0.81 +/- 0.21 for daily incontinence; P = .02). Women were willing to pay a mean of 70 dollars +/- 64 dollars per month for complete resolution of incontinence, and willingness to pay increased with income and greater expected benefit.

Conclusion: Women with severe urinary incontinence pay 900 dollars annually for incontinence routine care, and incontinence is associated with a significant decrement in health-related quality of life. Effective incontinence treatment may decrease costs and improve quality of life.

Level of evidence: III.

Fig. 1

Willingness to pay for improvement in incontinence. The percent of women willing to pay each dollar amount per month for varying levels of improvement in incontinence frequency is depicted. Women are willing to pay more for greater expected improvement in incontinence episode frequency, increasing from a mean of $28 per month for a 25% improvement to $70 for 100% improvement in incontinence episode frequency. Women were willing to pay more per month for increased expected improvement in incontinence episode frequency (P < .001 for trend). $2005 = value expressed in 2005 U.S. dollars.