The current and future burden and cost of overactive bladder in five European countries

OBJECTIVE: To estimate and compare the current and future direct cost of overactive bladder (OAB) to the health care systems of five European countries. METHOD: A health economic model was created to estimate the number of people currently affected by OAB symptoms, the expected number to be affected in the future, and the resultant economic burden on health care systems in Germany, Italy, Spain, Sweden, and the United Kingdom. RESULTS: The model estimated that in 2000, 20.2 million people over age 40 in the five countries experienced the symptoms of OAB; 7 million of these had urgency with urge incontinence. This figure is expected to rise to 25.5 million by 2020, including 9 million who will have urgency with urge incontinence. Average annual direct costs of OAB management ranged from euro269 to euro706 per patient per year. The largest cost was the use of incontinence pads, accounting for an average of 63% of the annual per patient cost of OAB management. Total cost to health care systems across all five countries was estimated at euro4.2 billion in 2000, and by 2020, the expected total cost was estimated to be euro5.2 billion, an increase of euro1 billion (26%). CONCLUSION: OAB is prevalent, with a substantial direct cost that is anticipated to increase in the future in line with aging populations. The overall burden, including indirect costs, may be considerably larger, and will fall predominantly on the elderly OAB population with urge incontinence. Recommended medical treatments could help manage those costs and should be evaluated.     

Health-related consequences of overactive bladder: an economic perspective

About 34 million people in the USA have an overactive bladder (OAB), a condition characterized by urinary urgency, with or without urinary incontinence, and usually frequency and nocturia. This condition is associated with increased health risks (e.g. urinary tract infection, falls and fall-related injuries, including broken bones), as well as admission to nursing homes and prolonged hospital stays. The annual costs associated with OAB in the community setting are >9 billion dollars, including 2.9 billion dollars for diagnosis and treatment, 1.5 billion dollars for routine care, 3.9 billion dollars for treatment of health-related consequences, and 841 million dollars in lost productivity. These cost patterns raise the possibility that treating OAB at an early stage may both improve patient care and minimize overall use of healthcare resources. However, before a thorough economic analysis of OAB can be undertaken, more data are needed about the long-term costs and the pathogenesis of OAB-related conditions.     

The economic impact of overactive bladder syndrome in six Western countries

OBJECTIVE

To calculate up‐to‐date estimates of the economic impact of overactive bladder syndrome (OAB) with and without urgency urinary incontinence (UUI) on the health sector of six countries (Canada, Germany, Italy, Spain, Sweden and the UK), as OAB is a significant health concern for adults aged >18 years living in Western countries.

MATERIALS AND METHODS

The prevalence data derived from the EPIC study were combined with healthcare resource‐use data to derive current direct and indirect 1‐year or annual cost of illness estimates for OAB including UUI in Canada, Germany, Italy, Spain, Sweden and the UK. This model estimates the direct healthcare costs attributed to OAB, as well as the impact of work absenteeism.

RESULTS

The estimated average annual direct cost of OAB per patient ranged between €262 in Spain and €619 in Sweden. The estimated total direct cost burden for OAB per country ranges between €333 million in Sweden and €1.2 billion in Germany and the total annual direct cost burden of OAB in these six countries is estimated at €3.9 billion. In addition, nursing home costs were estimated at €4.7 billion per year and it was estimated that work absenteeism related to OAB costs €1.1 billion per year.

CONCLUSIONS

The cost of illness for OAB is a substantial economic and human burden. This study may under‐estimate the true economic burden, as not all costs for sequelae associated with OAB have been included. Cost‐effective treatments and management strategies that can reduce the burden of OAB and in particular UUI have the potential to significantly reduce this economic burden.     

Epidemiology,treatment and costs of osteoporosis in Germany—the BoneEVA Study

INTRODUCTION: In Germany, accurate data on the prevalence and treatment of osteoporosis, as well as the cost of this illness, are not available. The aim of this study is to give a valid estimation of these items for the year 2003. METHODS: Routine data from a German sickness fund covering 1.5 million beneficiaries and billing data for outpatient visits were used to obtain estimates of prevalence for osteoporosis. Claims data for patients with osteoporosis (M80, M81) or an osteoporosis-related fracture diagnosis (S22, S32, S42, S52, S72, S82) or treatment with anti-osteoporosis drugs were examined. Costs were calculated from the perspective of the German health insurance system and the German nursing care insurance system, respectively. Only direct costs of osteoporosis were considered. RESULTS: In 2003, 7.8 million Germans (6.5 million women) were affected by osteoporosis. Of them, 4.3% experienced at least one clinical fracture. Only 21.7% were treated with an anti-osteoporosis drug. The total direct costs attributable to osteoporosis amounted to euros 5.4 billion. CONCLUSION: This study confirms that osteoporosis is underdiagnosed, undertreated and imposes a considerable economic burden on the health system in Germany. Effective strategies for the prevention and management of this disease are needed.     

Healthcare utilization and costs for spinal conditions in Ontario,Canada - opportunities for funding high-value care: a retrospective cohort study

BACKGROUND CONTEXTAn important step in improving spinal care is understanding how current health-care resources and associated cost are being utilized and distributed across a health-care system.PURPOSEOur objective was to examine the magnitude and distribution of direct health care costs for spinal conditions across physician type and hospital setting.DESIGN/SETTINGCross-sectional analysis of administrative health data for the fiscal year 2013–2014 from the province of Ontario, Canada.PATIENT SAMPLEAdult population aged 18+ years (N=10,841,302).OUTCOME MEASURESPerson visit rates and total number of people and visits by specific care settings were calculated for all spinal conditions as well as stratified by nontrauma and trauma-related conditions. Variation in rates by age and sex was examined. The proportion of patients seeing physicians of different specialties was calculated for each condition grouping. Direct medical costs were estimated and their percentage distribution by care setting calculated for nontrauma and trauma-related conditions. Additionally, costs for spinal imaging overall and stratified by type of scan were determined.METHODSAdministrative health databases were analyzed, including data on physician services, emergency department visits, and hospitalizations. ICD-9 and -10 diagnostic codes were used to identify nontraumatic (degenerative or inflammatory) and traumatic spinal disorders. A validated algorithm was used to estimate direct medical costs.RESULTSOverall, 822,000 adult Ontarians (7.6%) made 1.6 million outpatient physician visits for spinal conditions; the majority (1.1 million) of these visits were for nontrauma conditions. Approximately, 86% of outpatient visits were in primary care. Emergency Department (ED) visits for nontrauma spinal conditions (130,000 out of 156,000 ED visits) accounted for 2.8% of all ED visits in the province. Total costs for spine-related care were $264 million (CDN) with 64% of costs due to nontrauma conditions. For these nontrauma conditions, ED visits cost $28 million for 130,000 visits ($215 per visit). For $32 million spent in primary care, 890,000 visits were made ($36 per visit). Spine imaging costs were $66.5 million, yielding a combined total of $330 million in health care spending for spinal conditions.CONCLUSIONSSpinal conditions place a large and costly burden on the health-care system. The disproportionate annual cost associated with ED visits represents a potential opportunity to redirect costs to fund more clinically and cost-effective models of care for nontraumatic spinal conditions.     

Urologic diseases in North America Project: trends in resource utilization for urinary tract infections in children

PURPOSE: We evaluated the health utilization and economic burden on society of urinary tract infections (UTIs) in children using a variety of public and commercial health care databases. MATERIALS AND METHODS: Numerous available databases were evaluated for health care utilization, including inpatient hospitalization, and outpatient physician and emergency department visits, by children with a coded diagnosis of urinary tract infection. Utilization was analyzed by age, gender, race, insurance type and geographic location, and trends were assessed during the last decade. RESULTS: UTIs resulted in more than 1.1 million physician visits annually, accounting for 0.7% of doctor visits and occurring in 2.4% to 2.8% of children. Overall, inpatient hospitalization decreased slightly, although pyelonephritis still accounted for more than 13,000 admissions. Infants were more likely to receive inpatient care for UTIs than children or adolescents, although hospital costs were higher in adolescents. Inpatient hospital costs are estimated to be greater than 180 million dollars per year. CONCLUSIONS: Pediatric UTIs constitute a significant health burden on society. Available data do not allow a full accounting of costs due to a lack of information regarding outpatient expenses, as well as the cost of ancillary evaluation and treatment. However, the magnitude of the burden suggests the importance of further research and data collection of health care utilization in the pediatric population.     

The costs of caring for erectile dysfunction in a managed care setting: evidence from a large national claims database

PURPOSE: We examined the direct costs of erectile dysfunction (ED) empirically. MATERIALS AND METHODS: A naturalistic cohort study was done in 285,436 patients with ED and 51 health plans that covered 28 million lives nationwide from 1999 through 2001. Based on claims that had an ED related diagnosis code, procedure code or medication code we categorized the cost structure of ED care and calculated the annual costs of ED care per patient with ED, per user and per member monthly for individual and for all categories of ED care. RESULTS: A patient with ED in a health plan spent about an average of 83.91 dollars in 1999, 95.41 dollars in 2000 and 119.26 dollars in 2001 for ED care. In 2001, 37.08% of ED care costs per patient with ED were spent on phosphodiesterase type 5 (PDE-5) inhibitor therapy, 14.36% were spent on physician office visits, 10.19% were spent on diagnosis procedures, 8.45% were spent on testosterone hormone therapy, 3.85% were spent on penile prosthesis implantation, 4.41% were spent on intracavernous injection, 2.68% were spent on alprostadil pellet insertion and 0.81% was spent on vacuum erection devices. Of the 7 commonly used ED treatments PDE-5 inhibitor therapy has the lowest annual cost per user. CONCLUSIONS: In 2001 ED imposed a 122,669 dollars annual burden to a health plan with 100,000 members, that is or 0.108 dollars per member monthly. Each patient with ED spent 119.26 dollars annually for all ED related services or treatments. Of the 7 commonly used treatments PDE-5 inhibitor therapy had the lowest annual cost per user.     

The burden of illness of osteoporosis in Canadian men

There is a dearth of information about the burden of osteoporosis in Canadian men. To fill this gap, we conducted a burden of illness study aimed at estimating the economic burden attributable to osteoporosis in Canadian men aged 50 years and older. Five national data sources were used to estimate health care resource utilization and costs (in 2010 Canadian dollars) associated with osteoporosis in men. Any information gap was supplemented by using data from provincial and community sources. Direct medical costs included costs associated with hospitalizations, same day surgeries, emergency room visits, rehabilitation, chronic care, long-term care, home care, physician visits, and prescribed medications. The value of lost productivity from patients and informal caregivers was also determined to provide a societal perspective. Sensitivity analyses were conducted to evaluate the impact of key assumptions on the results. In fiscal year 2007/2008, the total economic burden of treating and rehabilitating male osteoporotic fractures was estimated at $570 million per year, where direct medical costs accounted for 86%. Acute care utilization was responsible for 70% of all direct costs. About 51% of all hospitalizations were for hip fractures and hip fractures alone accounted for 54% of the acute care spending. If a proportion of Canadian men were assumed to live in long-term care facilities due to osteoporosis, the overall annual cost of osteoporosis would increase from $570 million to $910 million. Male osteoporosis has a substantial economic burden on the Canadian society.     

Interstitial cystitis and painful bladder syndrome

PURPOSE: We quantified the burden of interstitial cystitis/painful bladder syndrome on the health care system in the United States. MATERIALS AND METHODS: The analytical methods used to generate these results were described previously. Interstitial cystitis was defined based on International Classification of Diseases, 9th revision code 595.1 (interstitial cystitis). For painful bladder syndrome we used the definition International Classification of Diseases, 9th revision code 788.41 (urinary frequency) with code 625.8 (other specified symptoms associated with female genital organs) or 625.9 (unspecified symptoms associated with female genital organs). RESULTS: Between 1992 and 2001 there was a 2-fold increase in the rate of hospital outpatient visits and a 3-fold increase in the rate of physician office visits related to interstitial cystitis. The annualized rate was 102 office visits per 100,000 population. Ambulatory surgery for interstitial cystitis decreased. A diagnosis of interstitial cystitis was associated with a 2-fold increase in direct medical costs. Between 1994 and 2000 annual national expenditures for interstitial cystitis were stable at $37 million but annual costs for painful bladder syndrome increased from $481 million to $750 million. CONCLUSIONS: Although interstitial cystitis accounts for a small percent of health care visits, its economic burden is substantial. Because of misdiagnosis, the true burden of interstitial cystitis/painful bladder syndrome on the health care system in the United States is probably underestimated in administrative data that rely only on physician coding to identify the disorder. The greatest part of the disease burden is likely not captured in this economic analysis.     

Ergebnisse der Implementierung eines Wundbehandlungsstandards im Haus der Maximalversorgung

In Germany, over four million patients with chronic wounds are treated annually, with annual medical costs amounting to over 4 billion euro. A substantial proportion of these costs involve the inpatient treatment for crural ulcer, the causes of diabetic foot syndrome and decubitus ulcer. Modern, stage-appropriate wound care can reduce the costs of wound therapy by reducing the changing intervals for wound dressing and faster healing of the wound. Despite these advantages, modern wound care with hydroactive dressings is not established throughout Germany, and, in particular, is still too rarely used in the outpatient sector of modern wound therapy. The introduction of interdisciplinary treatment standards in a maximum care hospital leads to a quality increase in wound therapy by the consistent application of modern, stage-appropriate treatment. Unfounded therapy changes, in particular after transfers into another department, can be avoided. Apart from the medical advantages, logistic and legal aspects also speak for the introduction of a wound treatment standard.     

Anticholinergic medication use for female overactive bladder in the ambulatory setting in the United States

Introduction and hypothesis

Our objective was to estimate the prevalence and sociodemographic factors associated with anticholinergic medication use by adult women for overactive bladder (OAB) in the United States.

Methods

We conducted a cross-sectional study using the 2009 National Ambulatory Medical Care Survey database (NAMCS). We included women aged 18 years and older and identified visits for which anticholinergic medications for OAB were in active use. We evaluated the prevalence of medications used and estimated the use of short-acting versus long-acting drugs. We also assessed variables associated with anticholinergic use, (age, race/ethnicity, insurance, geographic location) using survey weights in the analysis to estimate national data.

Results

In 2009, adult women made 516.8 million outpatient office visits. Of these, 8.1 million (1.6 %) were associated with an OAB anticholinergic medication (annual rate 68 per 1,000 women). Women who used anticholinergics were predominantly insured by Medicare (61.0 %) and were older than those not using anticholinergic medications (70.0?±?1.1 vs. 53.0?±?0.5, p?<?0.001). No racial or ethnic differences were evident between the two groups. Tolterodine (33.8 %) and oxybutynin (33.1 %) were the most commonly reported medications, followed by solifenacin (19.5 %), darifenacin (9.3 %), and trospium (4.4 %). Long-acting anticholinergics were used more often than short-acting medications (53.8 % vs. 46.3 %, respectively, p?<?0.001).

Conclusions

Annually, more than 8 million outpatient visits occur in which adult women in the United States are using an OAB anticholinergic medication. Despite the abundance of newer-generation medications, tolterodine and oxybutynin remain the most commonly prescribed anticholinergic drugs for OAB. Solifenacin is the most popular newer-generation anticholinergic drug.     

A health economic analysis of the use of rhBMP-2 in Gustilo–Anderson grade III open tibial fractures for the UK, Germany, and France

The purpose of this study was to determine the cost savings from a societal perspective for recombinant human Bone Morphogenetic Protein-2 (rhBMP-2) in grade III A and B open tibial fractures treated with a locked intramedullary nail and soft-tissue management in the UK, Germany, and France. Health care system costs (direct health care costs) and costs for productivity losses (indirect health care costs) were calculated using the raw data from the Bone Morphogenetic Protein Evaluation Group in Surgery for Tibial Trauma “BESTT study”. Return-to-work time for estimation of productivity losses was assumed to correspond with the time of fracture healing. For calculation of secondary interventions costs and productivity losses the respective 2007/2008 national tariffs for surgical procedures and average national wages for the UK, Germany, and France were used. For a 1 year perspective, overall treatment costs per patient after the initial surgery of the control vs. the rhBMP-2 group were €44,757 vs. €36,847 for the UK, €50,197 vs. €40,927 for Germany and €48,766 vs. €39,474 for France in favour of rhBMP-2 with overall savings overall savings per case of rhBMP-2 treatment of €7911 for the UK, €9270 for Germany, and €9291 for France which was mainly due to reduced productivity losses by significant faster fracture healing in the rhBMP-2 group (p = 0.01). These savings largely offset the upfront price of rhBMP-2 of €2266 (£1790) in the UK, €2970 in Germany, and €2950 in France. Total net savings can be estimated to be €9.6 million for the UK, €14.5 million for Germany, and €11.4 million for France. The results depend on the methodology used particularly for calculation of productivity losses and return-to-work time which was assumed to correspond with fracture healing time. In summary, despite the apparent high direct cost of rhBMP-2 in grade III A and B open tibial fractures, at a national level there are net cost savings from a societal perspective for all three countries.     

Medical visits among adults with symptoms commonly associated with an overactive bladder

OBJECTIVES: To examine nationally representative data and thus obtain estimates of the use of healthcare providers associated with the overactive bladder (OAB) symptoms, a condition characterized by frequency, urgency and nocturia, with or with no urge incontinence, as although it is ranked among the 10 most common chronic medical conditions in the USA, the level of OAB-associated medical treatment remains largely unknown. METHODS: To estimate the number of annual OAB-associated medical visits among patients aged > or =18 years, three national databases in the USA (year 2000) were examined: the National Ambulatory Medical Care Survey, the National Hospital Ambulatory Medical Care Survey, and the National Hospital Discharge Survey. Population estimates were constructed using design-based statistical analyses to account for the complex survey designs of data. RESULTS: During 2000, adult Americans made 1.4 million (95% confidence interval 1.1-1.8 million) ambulatory visits to non-Federal office-based physicians with International Classification of Disease (ICD-9) coding indicative of OAB symptoms. Accounting for emergency and outpatient department visits, as well as non-Federal short-stay hospital discharges, the estimated number of medical visits with OAB-associated ICD-9 coding was <1.5 million. CONCLUSION: The prevalence of OAB was estimated to be 34 million adult Americans. When 1.4 million ambulatory visits were compared with this prevalence, as few as 4% of adult Americans with OAB sought medical treatment during the year 2000. The present results therefore suggest a large unmet medical need among the population of adult Americans with OAB.     

Cost of care and clinical condition in paediatric cystic fibrosis patients.

BACKGROUND: The clinical course of cystic fibrosis (CF) shows considerable variation resulting in differences in health care utilisation. We investigated important clinical parameters and their relation to costs. METHODS: We collected clinical parameters together with health care utilisation of a representative paediatric CF population (n=138 patients) attending Hanover Medical School over a period of 1 year. 49% of the patients were chronically infected with Pseudomonas aeruginosa. Costs were calculated on the basis of the annual individual health care utilisation from the perspective of health insurance. RESULTS: Total annual expenditure per patient amounted to 23,989 euro (S.D. 18,026), with home drug treatment representing the most important single cost factor (47% of total costs). While costs rose with age and doubled in the first 18 years, they correlated foremost with P. aeruginosa airway colonisation status and lung function expressed as FEV(1). Costs of patients with chronic P. aeruginosa infection were more than three times higher than of uninfected patients. CONCLUSIONS: Health care expenditures for patients with CF vary with the clinical course. The variation can be explained to a large extend by clinical parameters.     

Zellbasierte Therapie der Belastungsinkontinenz

In Germany, 6–8 million woman and men suffer urinary incontinence, which represents 12.5?% of the population. It is estimated that by the middle of this century, it will increase to almost 30?%. The primary reason will be primarily related to the aging population but also to patient awareness and seeking a solution. In addition to the cost which is covered by the health insurance, the patient will spend more than half a billion euro/year out-of-pocket, not to mention the social stigma associated with urinary incontinence. The current common treatment options are symptomatic but do not restore functionality. One option might be tissue engineering or stem cell therapy.  This article describes the likelihood that this therapy will change the approach in treating stress urinary incontinence. Boundaries and legal aspects are highlighted as well as approximated cost. These treatment costs might be currently higher than the standard treatment options, but the investment to reduce these costs are paid indirectly by society.     

Cost of managing patients with venous leg ulcers

The aim of this study was to estimate costs associated with the management of patients with venous leg ulcers (VLUs) from the perspective of the UK National Health Service (NHS). The analysis was undertaken through the Secure Anonymised Information Linkage Databank which brings together and anonymously links a wide range of person‐based data from around 75% of general practitioner (GP) practices within Wales (population coverage ~2.5 million). The data covered an 11‐year period from 2007 to 2017. All patients linked to the relevant codes were tracked through primary care settings, recording the number of GP practice visits (number of days with an event recorded), and wound treatment utilisation (eg, dressings, bandages, etc.) Resources were valued in monetary terms (£ sterling) and the costs were determined from national published sources of unit costs. This is the first attempt to estimate the costs of managing of VLUs using routine data sources. The direct costs to the Welsh NHS are considerable and represent 1.2% of the annual budget. Nurse visits are the main cost driver with annual estimates of £67.8 million. At a UK level, these costs amount to £1.98 billion. Dressings and compression bandages are also major cost drivers with annual Welsh estimates of £828 790. The direct cost of managing patients with VLUs is £7706 per patient per annum, which translates to an annual cost of over £2 billion, when extrapolated to the UK population. The primary cost driver is the number of district nurse visits. Initiatives to reduce healing times through improving accuracy of initial diagnosis, and improved evidence‐based treatment pathways would result in major financial savings.     

Urologic diseases in America project: urolithiasis

PURPOSE: We quantified the burden of urolithiasis in the United States by identifying trends in the use of health care resources and estimating the economic impact of the disease. MATERIALS AND METHODS: The analytical methods used to generate these results have been described previously. RESULTS: The rate of national inpatient hospitalizations for a diagnosis of urolithiasis decreased by 15% and hospital length of stay decreased from 2.6 to 2.2 days between 1994 and 2000. Rates of hospitalization were 2.5 to 3-fold higher for Medicare beneficiaries with little change between 1992 and 1998. Almost 2 million outpatient visits for a primary diagnosis of urolithiasis were recorded in 2000. Hospital outpatient visits increased by 40% between 1994 and 2000 and physician office visits increased by 43% between 1992 and 2000. In the Medicare population hospital outpatient and office visits increased by 29% and 41%, respectively, between 1992 and 1998. The distribution of surgical procedures remained relatively stable through the 1990s. Shock wave lithotripsy was the most commonly performed procedure, followed closely by ureteroscopy. Overall the total estimated annual expenditure for individuals with claims for a diagnosis of urolithiasis was almost $2.1 billion in 2000, representing a 50% increase since 1994. CONCLUSIONS: The cost of urolithiasis is estimated at almost $2 billion annually and it appears to be increasing with time despite a shift in inpatient to outpatient treatment and the emergence of minimally invasive treatment modalities, perhaps because the prevalence of stone disease is increasing.