1 Vanderbilt University Medical Center, Nashville, Tennessee.
2 New York University, Langone Health, New York, New York.
J Manag Care Spec Pharm. 2019 May;25(5):593-604. doi: 10.18553/jmcp.2019.18067. Epub 2019 Jan 24.
Nocturia is considered to be a very bothersome lower urinary tract disorder. Yet, to date, the economic burden attributable to this poor health condition remains less well known.
To compare differences in health care resource utilization (HCRU), health care costs, and work productivity in adult patients with differing frequencies of nocturia episodes (i.e., < 2 vs. ≥ 2 nocturia episodes per night).
Adult patients with nocturia enrolled in an integrated proprietary database were recruited to complete a survey on their demographics, nocturia characteristics, and work productivity. Using patients' survey data and health care claims from the previous 6 months, those with < 2 (n = 197; 21.9%) versus ≥ 2 (n = 702; 78.1%) nocturia episodes per night were compared for differences in HCRU, health care costs, and work productivity after adjusting for potential confounders. HCRU was reported as the mean number per patient per month (PPPM) for outpatient visits (all types), physician office visits, and prescriptions filled and the proportion of patients with ≥1 hospitalization or emergency department visit in the previous 6 months. Health care costs were reported as mean PPPM. Work productivity was assessed via patient survey and reported as a mean percentage for absenteeism, presenteeism, overall work impairment, and activity impairment during the past week.
899 adult patients (mean age = 71.4 years; 57.2% men) were enrolled and analyzed. Compared with patients with <2 nocturia episodes per night, patients with ≥ 2 nocturia episodes had more outpatient health care visits (unadjusted mean visits PPPM: 2.1 vs. 1.6; < 0.001; adjusted mean visits PPPM: 2.1 vs. 1.6; = 0.017), office visits (unadjusted and adjusted mean visits PPPM: 0.9 vs. 0.7; < 0.001), and prescriptions filled (unadjusted mean prescription fills PPPM: 3.1 vs. 2.1; < 0.001; adjusted mean prescription fills PPPM: 3.2 vs. 2.2; = 0.027). Patients with ≥ 2 nocturia episodes per night also displayed significantly higher outpatient health care costs (unadjusted mean PPPM costs: $676 vs. $516; = 0.028; adjusted mean PPPM costs: $678 vs. $506; = 0.017). In terms of work productivity impairment, patients with ≥ 2 nocturia episodes per night experienced higher rates of unadjusted (20% vs. 10%; = 0.002) and adjusted presenteeism (20% vs. 10%; = 0.004) and unadjusted (20% vs. 10%; = 0.002) and adjusted overall work impairment (20% vs. 10%; = 0.001).
Study findings demonstrate that nocturia was associated with higher outpatient encounters and related costs in the presence of a greater occurrence of nocturic episodes.
This study was funded by Allergan plc, Dublin, Ireland. Neither honoraria nor payments were provided for authorship. Dmochowski is a consultant and speaker for Allergan plc and a consultant for Serenity Pharmaceuticals. Brucker is a consultant and speaker for Allergan plc, a consultant for Watkins-Conti and Avadel, and an investigator for Medtronic and Ipsen. Cole is a consultant for Allergan plc and an employee of Sharp Rees-Stealy Medical Group. Kawahara and Pulicharam are full-time employees of DaVita Medical Group. Burk is a consultant for Allergan plc and a health outcomes consultant. Tung is an employee of Allergan plc. Hale has served as a consultant/advisor to and has received research funding from Allergan plc. The data from this manuscript were previously presented in poster format by Steve Kawahara at the Academy of Managed Care & Specialty Pharmacy Annual Meeting; April 19-22, 2016; San Francisco, CA.
夜尿症被认为是一种非常恼人的下尿路疾病。然而，迄今为止，这种健康状况所带来的经济负担还不太为人所知。
比较不同夜尿次数（每晚<2 次与≥2 次）的成年患者之间的医疗保健资源利用（HCRU）、医疗保健成本和工作生产力的差异。
招募患有夜尿症并纳入内部专有数据库的成年患者完成有关其人口统计学、夜尿症特征和工作生产力的调查。使用患者的调查数据和前 6 个月的医疗保健索赔，比较每晚<2（n=197；21.9%）和≥2（n=702；78.1%）次夜尿发作的患者在调整潜在混杂因素后 HCRU、医疗保健成本和工作生产力的差异。HCRU 以每月每位患者的平均就诊次数（所有类型）、医生就诊次数和处方填写次数报告（PPPM），以及前 6 个月内≥1 次住院或急诊就诊的患者比例报告。医疗保健成本以平均每月每位患者的就诊次数（PPPM）报告。工作生产力通过患者调查评估，并报告过去一周缺勤、出勤、整体工作障碍和活动障碍的平均百分比。
共纳入和分析了 899 名成年患者（平均年龄=71.4 岁；57.2%为男性）。与每晚夜尿次数<2 次的患者相比，每晚夜尿次数≥2 次的患者门诊就诊次数更多（未经调整的平均就诊次数 PPPM：2.1 次 vs. 1.6 次；<0.001；调整后的平均就诊次数 PPPM：2.1 次 vs. 1.6 次；=0.017），就诊次数（未经调整和调整后的平均就诊次数 PPPM：0.9 次 vs. 0.7 次；<0.001）和处方填写次数（未经调整的平均处方填写次数 PPPM：3.1 次 vs. 2.1 次；<0.001；调整后的平均处方填写次数 PPPM：3.2 次 vs. 2.2 次；=0.027）。每晚夜尿次数≥2 次的患者门诊医疗保健费用也明显更高（未经调整的平均 PPPM 费用：676 美元 vs. 516 美元；=0.028；调整后的平均 PPPM 费用：678 美元 vs. 506 美元；=0.017）。在工作生产力受损方面，每晚夜尿次数≥2 次的患者未调整（20% vs. 10%；=0.002）和调整后的出勤障碍（20% vs. 10%；=0.004）和未调整（20% vs. 10%；=0.002）和调整后的整体工作障碍（20% vs. 10%；=0.001）的发生率更高。
研究结果表明，夜尿症与更高的门诊就诊次数和相关费用相关，同时夜尿发作次数更多。
本研究由爱尔兰的艾尔建制药公司资助。作者没有获得酬金或报酬。Dmochowski 是艾尔建制药公司的顾问和发言人，也是 Serenity Pharmaceuticals 的顾问。Brucker 是艾尔建制药公司的顾问和发言人，Watkins-Conti 和 Avadel 的顾问，以及 Medtronic 和 Ipsen 的研究员。Cole 是艾尔建制药公司的顾问，也是 Sharp Rees-Stealy Medical Group 的员工。Kawahara 和 Pulicharam 是 DaVita Medical Group 的全职员工。Burk 是艾尔建制药公司的顾问和健康结果顾问。Tung 是艾尔建制药公司的员工。Hale 曾担任艾尔建制药公司的顾问/顾问，并获得该公司的研究资金。本文的数据以前由 Steve Kawahara 以海报的形式在管理式医疗和专科药房年度会议上展示；2016 年 4 月 19-22 日；旧金山，加利福尼亚州。
