Goren A, Zou K H, Gupta S, Chen C
Kantar Health, New York, NY, USA.
Int J Clin Pract. 2014 Mar;68(3):336-48. doi: 10.1111/ijcp.12301. Epub 2013 Dec 22.
To evaluate the impact of treating urge urinary incontinence (UUI), including mixed urinary incontinence (MUI), on healthcare resource utilisation, productivity, activity impairment and associated costs.
The study used data from the 2011 U.S. National Health and Wellness Survey, an Internet-based questionnaire of a nationwide sample of adults. UUI or MUI respondents were identified via three Incontinence Questions. Respondents with stress urinary incontinence only, prostate cancer or (medication for) benign prostatic hyperplasia were excluded. UUI/MUI respondents were categorised as Rx users for overactive bladder (OAB) and non-Rx users (who never used Rx and whose condition reportedly interfered with life activities or was difficult to manage). Outcome measures included healthcare utilisation and Work Productivity and Activity Impairment questionnaire-based scores. Direct and indirect costs were estimated using 2010 labour and 2008 medical expenditure data sources. Generalised linear models predicted resource use and productivity as a function of treatment status, adjusting for covariates (e.g. sociodemographics, OAB severity, comorbid status) that may also predict impairment.
Rx (vs. non-Rx) users were more likely to be female (80.7% vs. 70.0%), older (mean = 62.7 vs. 53.1) and reporting more moderate-to-severe OAB (70.9% vs. 52.6%; all p < 0.05). Adjusting for covariates, Rx (vs. non-Rx) users had significantly lower activity impairment (41.1% vs. 46.8%), more provider visits (7.42 vs. 5.60) and costs ($18,175 vs. $13,679), and higher total direct costs ($27,291 vs. $21,493), all p < 0.01.
Urge urinary incontinence patients using, vs. never using, prescription medication reported lower activity impairment but higher direct costs. These findings may inform the degree to which UUI pharmacotherapy affects health outcomes.
评估治疗急迫性尿失禁（UUI），包括混合性尿失禁（MUI），对医疗资源利用、生产力、活动障碍及相关成本的影响。
本研究使用了2011年美国国家健康与 Wellness 调查的数据，这是一项基于互联网的针对全国成年样本的问卷调查。通过三个尿失禁问题识别出UUI或MUI受访者。仅患有压力性尿失禁、前列腺癌或良性前列腺增生（药物治疗）的受访者被排除。UUI/MUI受访者被分类为膀胱过度活动症（OAB）的处方药使用者和非处方药使用者（从未使用过处方药且其病情据报告干扰生活活动或难以管理）。结果指标包括医疗利用情况以及基于工作生产力和活动障碍问卷的得分。使用2010年劳动力数据和2008年医疗支出数据源估算直接和间接成本。广义线性模型预测资源使用和生产力作为治疗状态的函数，并对可能也预测障碍的协变量（如社会人口统计学、OAB严重程度、共病状态）进行调整。
处方药使用者（与非处方药使用者相比）更可能为女性（80.7%对70.0%）、年龄更大（平均年龄 = 62.7对53.1）且报告有更多中重度OAB（70.9%对52.6%；所有p < 0.05）。在调整协变量后，处方药使用者（与非处方药使用者相比）的活动障碍显著更低（41.1%对46.8%）、看诊次数更多（7.42次对5.60次）且成本更高（18,175美元对13,679美元），总直接成本也更高（27,291美元对21,493美元），所有p < 0.01。
使用过与从未使用过处方药的急迫性尿失禁患者相比，前者活动障碍更低，但直接成本更高。这些发现可能为UUI药物治疗对健康结果的影响程度提供参考。
