National public health policies for prevention and care in urinary incontinence in the elderly

Cost Effectiveness of Controlled-Release Oxybutynin Compared with Immediate-Release Oxybutynin and Tolterodine in the Treatment of Overactive Bladder in the UK, France and Austria

OBJECTIVE

To estimate the cost effectiveness of controlled-release (CR) oxybutynin compared with immediate-release (IR) oxybutynin and tolterodine in the treatment of overactive bladder (OAB) in Austria, France and the UK.

DESIGN AND SETTING

This was a modelling study on the management of patients with OAB who were >/=18 years of age, and had urge or mixed incontinence with a primary-urge component. The study was performed from the perspective of payers (i.e. the National Health Service [NHS] in the UK, Social Security in France and the Sick Funds in Austria) and patients.

METHODS

Clinical outcomes attributable to managing OAB were obtained from the published literature, and resource utilisation estimates were derived from a panel of clinicians. Using decision analytical techniques, three decision models were constructed depicting the management of OAB with CR oxybutynin, IR oxybutynin and tolterodine over 6 months in the UK, France and Austria. The models were used to estimate the cost effectiveness of CR oxybutynin relative to the other two anticholinergic drugs in each of the three countries and the expected direct patient costs and indirect societal costs (at 2000/2001 prices).

MAIN OUTCOME MEASURES AND RESULTS

Starting OAB treatment with CR oxybutynin instead of either IR oxybutynin or tolterodine in the UK and Austria was found to be a potentially dominant strategy, since it improves clinical outcome at a lower cost, from the payers' perspective. In France, starting OAB treatment with CR oxybutynin instead of either the IR formulation or tolterodine was found to be a potentially cost-effective strategy from the payer's perspective. The expected 6-monthly direct costs to patients were euro230, euro720-920 and euro970-1000 in the UK, France and Austria, respectively. In the UK and Austria, these costs were broadly consistent between initial treatments. However, in France, tolterodine-treated patients would be expected to incur 28% more expenditure than patients treated with the other two drugs. Transportation emerged as the primary cost driver, accounting for at least 60% of patients' out-of-pocket expenditure, in all three countries. Irrespective of the initial treatment, patients would be expected to miss 1-2 days of work over 6 months as a result of their OAB. This equates to an expected lost productivity cost of euro84, euro250 and euro98 in the UK, France and Austria, respectively.

CONCLUSION

Starting OAB treatment with CR oxybutynin is expected to be a clinically more effective strategy than starting with either IR oxybutynin or tolterodine, and potentially the most cost-effective strategy in all three countries.

Increasing costs of urinary incontinence among female Medicare beneficiaries

PURPOSE

We measured the financial burden of urinary incontinence in the United States from 1992 to 1998 among women 65 years old or older.

MATERIALS AND METHODS

We analyzed Medicare claims for 1992, 1995 and 1998 and estimated spending on the treatment of urinary incontinence. Total costs were stratified by type of service (inpatient, outpatient and emergency department).

RESULTS

Costs of urinary incontinence among older women nearly doubled between 1992 and 1998 in nominal dollars, from $128 million to $234 million, primarily due to increases in physician office visits and ambulatory surgery. The cost of inpatient services increased only slightly during the period. The increase in total spending was due almost exclusively to the increase in the number of women treated for incontinence. After adjusting for inflation, per capita treatment costs decreased about 15% during the study.

CONCLUSIONS

This shift from inpatient to outpatient care likely reflects the general shift of surgical procedures to the outpatient setting, as well as the advent of new minimally invasive incontinence procedures. In addition, increased awareness of incontinence and the marketing of new drugs for its treatment, specifically anticholinergic medication for overactive bladder symptoms, may have increased the number of office visits. While claims based Medicare expenditures are substantial, they do not include the costs of pads or medications and, therefore, underestimate the true financial burden of incontinence on the aging community.

Health status and health care services among older persons in India

India is characterized by significant rural-based living, population heterogeneity, financial constraints, and reverse sex ratio. Traditions of joint families, life-long physical activity, vegetarianism, and social and spiritual enrichment, all known to promote healthy aging, are widely prevalent. With the increasing pace of population aging, the health of older persons in India has been the focus of recent attention. Existing data indicate a significant morbidity among the aged, much of which may remain subclinical. Considerable variations in morbidity exist with respect to gender, place of residence (rural vs. urban), and socioeconomic status. Rapid demographic transition without a concomitant epidemiological transition is responsible for the dual load of infections and degenerative diseases in older persons, these being common causes of death. Most age-related morbidity is preventable. Health promotion and cost-effective interventions based on the primary health care approach over a lifelong course, especially at the village level, will greatly help towards achieving the goal of healthy aging. The rapidly changing socioeconomic scenario in India also calls for appropriate policy actions to achieve this goal.