The relative importance of health related quality of life and prescription insurance coverage in the decision to pharmacologically manage symptoms of overactive bladder.

PURPOSE: Patient decisions to seek treatment for overactive bladder are influenced by the impact of the condition on health related quality of life and the presence of prescription insurance coverage. This study uses conjoint analysis to examine the relative importance of health related quality of life dimensions of the overactive bladder questionnaire and the presence of prescription insurance coverage on patient preference for treatment. MATERIALS AND METHODS: Patient preferences were elicited using a study questionnaire that included 9 hypothetical profiles containing an orthogonal array of attributes relating to coping with symptoms, symptom concern, sleep disturbances, problems with social interactions and prescription insurance coverage. This questionnaire was administered to 150 patients with self-reported symptoms of overactive bladder. Patients responded to each profile with the likelihood that they would prefer drug therapy to control overactive bladder symptoms versus doing nothing. RESULTS: A total of 133 usable responses were obtained from participants. Analysis was conducted with a linear random effects model. Of the 5 included attributes prescription insurance coverage was the most important attribute followed by sleep disturbances, symptom concern, social interaction problems and coping. Responses obtained from attribute ratings using visual analog scaling and a holdout profile demonstrated study validity. CONCLUSIONS: Prescription insurance coverage and sleep disturbances are important considerations underlying patient preferences for the treatment of overactive bladder.

Estimated economic costs of overactive bladder in the United States.

OBJECTIVES: To estimate the economic costs of overactive bladder (OAB), including community and nursing home residents, and to compare the costs in male versus female and older versus younger populations. METHODS: The National Overactive Bladder Evaluation Program included a representative telephone survey of 5204 community-dwelling adults 18 years and older in the United States and a follow-up postal survey of all individuals with OAB identified and age and sex-matched controls. The postal survey asked respondents about bladder symptoms, self-care use, treatment use, work loss, and OAB-related health consequences. Survey data estimates were combined with year 2000 average cost data to calculate the cost of OAB in the community. Institutional costs were estimated from the costs of urinary incontinence in nursing homes, limited to only those with urge incontinence or mixed incontinence (urge and stress). RESULTS: The estimated total economic cost of OAB was 12.02 billion dollars in 2000, with 9.17 and 2.85 billion dollars incurred in the community and institutions, respectively. Community female and male OAB costs totaled 7.37 and 1.79 billion dollars, respectively. The estimated total cost was sensitive to the estimated prevalence of OAB; therefore, we calculated the average cost per community-dwelling person with OAB, which was 267 dollars per year. CONCLUSIONS: By quantifying the total economic costs of OAB, this study-the first obtained from national survey data-provides an important perspective of this condition in society. The conservative estimates of the total cost of OAB were comparable to those of osteoporosis and gynecologic and breast cancer. Although this provides information on the direct and indirect costs of OAB, quality-of-life issues must be taken into account to gain a better understanding of this condition.

Overactive bladder patients and role of the pharmacist.

OBJECTIVES: To summarize the prevalence, quality of life (QOL) implications, cost of illness, and pharmacotherapy of overactive bladder (OAB), and to describe the pharmacist's role in the management of patients with OAB. DATA SOURCES: Articles published between 1990 and 2001 identified through a MEDLINE search using the terms overactive bladder, unstable bladder, urinary incontinence, prevalence, cost of illness, quality of life, drug therapy, pharmacist, and pharmacy in various combinations. STUDY SELECTION: All studies providing information on OAB or urinary incontinence were retrieved. DATA EXTRACTION: By the authors. DATA SYNTHESIS: Published prevalence and cost studies focus primarily on urinary incontinence, which is only one possible symptom of OAB. Reported prevalence rates of urge and mixed incontinence in the United States range from 3% to 8% and 5% to 37%, respectively, and the highest prevalence has been found in geriatric and psychogeriatric populations. Associated costs are substantial. Total costs of OAB in the United States were estimated to be $12.6 billion in 2000. Patients with OAB score lower than the general population in QOL assessments. All aspects of QOL can be compromised by OAB, as physical, social, occupational, domestic, and sexual activities are often limited in OAB patients. The pharmacist is instrumental in improving an individual's QOL through ensuring safe and effective treatment for OAB. Oxybutynin and tolterodine (Detrol-Pharmacia) have been the mainstays of pharmacotherapy for OAB, but frequent adverse effects (including dry mouth) often prevent patients from adhering to treatment. Tolterodine, now available in a new long-acting formulation, has been proven safe and efficacious in the treatment of OAB, with fewer adverse effects and better tolerability than existing agents. CONCLUSION: Pharmacists can play an active role in helping identify and recommending interventions for OAB that can ultimately improve an individual's QOL.

Health-related consequences of overactive bladder.

OBJECTIVE: Overactive bladder (OAB) is a condition of urgency, with or without urge incontinence, usually with frequency and nocturia. This study assesses whether people with OAB are at greater risk for urinary tract infections (UTIs), falls and injuries, and increased number of visits to the doctor compared to age- and gender-matched controls. The study also estimates costs associated with these health-related consequences. PATIENTS & METHODS: A US representative telephone survey under the National Overactive Bladder Evaluation (NOBLE) Program was conducted with 5204 English-speaking adults older than 18 years. The survey asked respondents about bladder symptoms. Based on the telephone survey, 865 symptom-identified OAB cases and 903 age- and gender-matched controls were sent a postal questionnaire. A total of 397 cases and 522 controls returned the questionnaires. Nonrespondent cases and controls did not differ with regard to age, gender, educational status, diabetes, congestive heart failure, and self-rated health status. Regression analyses were conducted to assess the effect of OAB on health-related consequences, controlling for age, gender, race, education, marital status, number of previous births, self-reported health status, diabetes, and congestive heart failure. RESULTS: People with OAB reported 0.84 (20%) more visits to the physician (P < .05) and 0.21 (138%) more UTIs in the last year than people without OAB (P < .001). Overactive bladder cases also had over twice the odds of being injured in a fall than people without OAB (odds ratio = 2.26; 95% confidence interval 1.46, 3.51). Consistent with having more falls, OAB cases had an increased risk of bone fracture (P < .1). This effect, however, was not statistically significant (at alpha level 0.05) due to the limited sample size. The estimated cost of UTIs associated with OAB was approximately $1.37 billion US dollars in year 2000. The cost of falls without bone fracture due to OAB was $55 million. Falls with bone fracture accounted for approximately $386 million; however, further research with a larger sample is needed to accurately estimate these costs. CONCLUSION: People with OAB self-report significantly more UTIs and a greater risk of being injured in a fall. Given the large prevalence of UTIs and concerns of overprescribing antibiotics, these results are important for health plans and policy makers. In addition, people with OAB visit their physicians more often than people without OAB. These consequences entail significant economic costs, of which a large percentage will be incurred by health plans. To the extent that OAB causes these consequences, there may be significant savings from effectively treating OAB.