High costs of urinary incontinence among women electing surgery to treat stress incontinence

Abstract

Objective: To estimate costs for incontinence management, health-related quality of life, and willingness to pay for incontinence improvement in women electing surgery for stress urinary incontinence.

Methods: A total of 655 incontinent women enrolled in the Stress Incontinence Surgical Treatment Efficacy Trial, a randomized surgical trial. Baseline out-of-pocket costs for incontinence management were calculated by multiplying self-report of resources used (supplies, laundry, dry cleaning) by national resource costs (USD2,006). Health-related quality of life was estimated with the Health Utilities Index Mark 3. Participants estimated willingness to pay for 100% improvement in incontinence. Potential predictors of these outcomes were examined by using multivariable linear regression.

Results: Mean age was 52+/-10 years, and mean number of weekly incontinence episodes was 22+/-21. Mean and median (25%, 75% interquartile range) estimated personal costs for incontinence management among all women were USD14+/-USD24 and USD8 (interquartile range USD3, USD18) per week, and 617 (94%) women reported any cost. Costs increased significantly with incontinence frequency and mixed compared with stress incontinence. The mean and median Health Utilities Index Mark 3 scores were 0.73+/-0.25 and 0.84 (interquartile range 0.63, 0.92). Women were willing to pay a mean of USD118+/-USD132 per month for complete resolution of incontinence, and willingness to pay increased significantly with greater expected incontinence improvement, household income, and incontinent episode frequency.

Conclusion: Urinary incontinence is associated with substantial costs. Women spent nearly USD750 per year out of pocket for incontinence management, had a significant decrement in quality of life, and were willing to pay nearly USD1,400 per year for cure.

Fig. 1

Willingness to pay for alleviation of incontinence. The proportion of women willing to pay each dollar amount per month for 25%, 50%, and 100% reduction in incontinence frequency is depicted. Women were willing to pay more for greater expected reduction in incontinent episode frequency (P<.001 for trend). The dotted line is the current monthly cost for incontinence management for all women in the Stress Incontinence Surgical Treatment Efficacy trial (SISTEr) ($61 per month) and dashed line is the mean willingness to pay per month for incontinence cure ($118 per month).

Fig. 2

Mean of Health Utilities Index (HUI3) scores in published population-based, cross-sectional studies of chronic health conditions. The shaded bar is the mean HUI3 score observed in the current study.