Department of Neurological Surgery, Keck School of Medicine, University of Southern California, Los Angeles, California.
University of Southern California Neurorestoration Center, Los Angeles, California.
J Urol. 2022 Oct;208(4):773-783. doi: 10.1097/JU.0000000000002862. Epub 2022 Jul 28.
The clinical, social, and economic impacts of neurogenic lower urinary tract dysfunction (NLUTD) on individuals and health care systems are thought to be immense, yet the true costs of care are unknown. The aims of this study are to illuminate the global costs related to the current state of care for NLUTD.
A systematic review of the literature was performed using MEDLINE, the National Health Service Economic Evaluation Database, and the Cochrane Specialized Urology and Incontinence Registers. Studies reporting the health care costs of NLUTD were identified. All steps of the review were performed by 2 independent reviewers. Costs were converted to 2022 U.S. dollars and reported for different categories of services.
A total of 13 studies were included in the final review (12 from high-income economy, and 1 from an upper-middle-income economy). Routine maintenance care varied notably across studies in terms of included services. Annual supportive costs ranged from $2,039.69 to $12,219.07 with 1 study estimating lifetime costs of $112,774 when complications were considered. There were limited data on the costs of care from the patient's perspective. However, catheters and absorbent aids were estimated to be among the costliest categories of expenditure during routine care. More invasive and reconstructive treatments were associated with significant costs, ranging between $18,057 and $55,873.
NLUTD incurs a variety of health care expenditures ranging from incontinence supplies to hospitalizations for management of complications and leads to a significant burden for health care systems over the patient's lifetime. Approaches to NLUTD that focus on functional rehabilitation and restoration, rather than on management of complications, may prove to be a less costly and more effective alternative.
据认为，神经源性下尿路功能障碍（NLUTD）给个人和医疗保健系统带来的临床、社会和经济影响是巨大的，但护理的实际成本却不得而知。本研究旨在阐明与 NLUTD 现有护理状态相关的全球成本。
使用 MEDLINE、英国国家卫生服务经济评估数据库和 Cochrane 专门泌尿科和尿失禁登记处对文献进行了系统回顾。确定了报告 NLUTD 医疗保健成本的研究。审查的所有步骤均由 2 名独立审查员进行。将成本转换为 2022 年的美元，并按不同类别的服务报告。
最终综述共纳入 13 项研究（12 项来自高收入经济体，1 项来自中上收入经济体）。常规维持性护理在纳入的服务方面在不同研究中差异显著。支持性年度费用从 2039.69 美元到 12219.07 美元不等，有 1 项研究在考虑并发症时估计终生费用为 112774 美元。从患者角度来看，护理成本的数据有限。然而，导管和吸收性辅助器具估计是常规护理中最昂贵的支出类别之一。更具侵入性和重建性的治疗与显著的成本相关，范围在 18057 美元至 55873 美元之间。
NLUTD 会产生各种医疗保健支出，从失禁用品到因并发症管理而住院，在患者的一生中给医疗保健系统带来重大负担。专注于功能康复和恢复而不是并发症管理的 NLUTD 方法可能被证明是一种成本更低、更有效的替代方法。
