The Economic Burden of Nocturia on the U.S. Health Care System and Society: A National Health and Nutrition Examination Survey Analysis

The cost of lifelong LUTS-A systematic literature review

BACKGROUND

Lower urinary tract symptoms (LUTS) are highly prevalent and very bothersome. To support the best possible allocation of health care resources and to avoid unnecessary expenditures, it is important to understand and quantify the wide-ranging health care costs affecting people suffering from LUTS. We aimed at creating a foundation for exploring the cost of LUTS.

METHOD

In this systematic literature review, we explored the costs of illness of the LUTS umbrella. We used the online literature review tool Silvi.ai for transparent decision-making and literature management.

RESULTS

A total of 1821 original articles were screened. Forty had explored the cost of illness of a LUTS disease since 2013. The studies were conducted in 18 countries. A number of different study designs were applied, including both retrospective and prospective studies. In total, seven LUTS indications were explored. None of them focused on lifelong LUTS. None of them were conducted in infants or children. Eighty-two percent were conducted in adults and 18% in frail elderly. Most cost of illness studies focused on the cost of hospitalization and use of medicine.

CONCLUSION

We have created the groundwork for understanding the cost of LUTS illness. To fully understand the cost of illness of lifelong LUTS, the main gap in research is to investigate the cost of LUTS in infants and children.

Association between TV and/or video time and nocturia in adults: An analysis of the National Health and Nutrition Examination Survey

AIMS

This study aimed to examine the correlation between television (TV) and/or video viewing time and the occurrence of nocturia in adults.

METHODS

An analysis of data from the National Health and Nutrition Examination Survey for 2011-2016 was conducted, involving 13 294 adults aged 20 and older. The main outcome was specified as nocturia, which refers to the requirement of urinating two or more times during the night. Initially, baseline characteristics were contrasted between individuals with and without nocturia. The effects of TV and/or video viewing time on nocturia were further explored using multivariable logistic regression models. To acknowledge the variation in baseline data regarding the prevalence of nocturia, subgroup analyses were performed.

RESULTS

Adjusted multivariate analysis revealed that individuals in the group with the longest TV and/or video viewing time had a significantly 48% higher risk of experiencing nocturia compared to those with the shortest TV and/or video viewing time. The results of subgroup analyses revealed no significant differences in the interaction tests between TV and/or video viewing time and nocturia.

CONCLUSIONS

Our research showed that individuals who spent 5 or more hours a day watching TV and/or videos were significantly more likely to develop nocturia.

Partially different? The importance of general equilibrium in health economic evaluations: An application to nocturia

Both the human capital approach and the friction cost approach are frequently used to quantify the productivity costs associated with illness, disability or death in health economic evaluations. In this paper we argue that these approaches have one major, but common shortcoming: they only capture partial equilibrium (PE) effects and therefore underestimate the true potential productivity costs associated with health conditions. They neglect the sizable, indirect, ripple effects in the economy captured by general equilibrium (GE) models. To demonstrate our point, we compare a traditional PE with a GE approach for the application to nocturia, a condition characterized by the need to frequently wake up at night to urinate. Nocturia is associated with substantial impairment of daytime functioning and work productivity. We employ large-scale United Kingdom (UK) employer-employee survey data to estimate the prevalence and productivity loss. These estimates are then used as shared inputs to drive both approaches. We find that the traditional PE approach underestimates the annual productivity cost of clinically relevant nocturia by around 16%. We propose a generalized GE/PE multiplier to approximate the GE effect for other health conditions. Our findings stress the importance of accounting for sizable GE effects when conducting health economic evaluations.

Using Search Trends to Analyze Web-Based Interest in Lower Urinary Tract Symptoms-Related Inquiries, Diagnoses, and Treatments in Mainland China: Infodemiology Study of Baidu Index Data

Background

Lower urinary tract symptoms (LUTS) are one of the most commonly described urination disorders worldwide. Previous investigations have focused predominantly on the prospective identification of cases that meet the researchers’ criteria; thus, the genuine demands regarding LUTS from patients and related issues may be neglected.

Objective

We aimed to examine web-based search trends and behaviors related to LUTS on a national and regional scale by using the dominant, major search engine in mainland China.

Methods

Baidu Index was queried by using LUTS-related terms for the period of January 2011 to September 2020. The search volume for each term was recorded to analyze search trends and demographic distributions. For user interest, user demand graph data and trend data were collected and analyzed.

Results

Of the 13 LUTS domains, 11 domains are available in the Baidu Index database. The Baidu search index for each LUTS domain varied from 37.78% to 1.47%. The search trends for urinary frequency (2011-2018: annual percent change APC=7.82%; P<.001), incomplete emptying (2011-2014: APC=17.74%; P<.001), nocturia (2011-2018: APC=11.54%; P<.001), dysuria (2017-2020: APC=20.77%; P<.001), and incontinence (2011-2016: APC=13.39%; P<.001) exhibited fluctuations over time. The search index trends for weak stream (2011-2017: APC=−4.68%; P<.001; 2017-2020: APC=9.32%; P=.23), split stream (2011-2013: APC=9.50%; P=.44; 2013-2020: APC=2.05%; P=.71), urgency (2011-2018: APC=−2.63%; P=.03; 2018-2020: APC=8.58%; P=.19), and nocturnal enuresis (2011-2018: APC=−3.20%; P=.001; 2018-2020: APC=−4.21%; P=.04) remained relatively stable and consistent. The age distribution of the population for all LUTS-related inquiries showed that individuals aged 20 to 40 years made 73.86% (49,218,123/66,635,247) of the total search inquiries. Further, individuals aged 40 to 49 years made 12.29% (8,193,922/66,635,247) of the total search inquiries for all LUTS-related terms. People from the east part of China made 67.79% (45,172,031/66,635,247) of the total search queries. Additionally, most of the searches for LUTS-related terms were related to those for urinary diseases to varying degrees.

Conclusions

Web-based interest in LUTS-related terms fluctuated wildly and was reflected timely by Baidu Index in mainland China. The web-based search popularity of each LUTS-related term varied significantly and differed based on personal interests, the population’s concerns, regional variations, and gender. These data can be used by care providers to track the prevalence of LUTS and the population’s interests, guide the establishment of disease-specific health care policies, and optimize physician-patient health care sessions.

Mechanisms and grading of nocturia: Results from a multicentre prospective study

OBJECTIVE

To identify the pathophysiological mechanisms of nocturia and the correlation of these mechanisms with nocturia severity.

METHODOLOGY

After approval by the local ethics committee, all patients with nocturia (≥1 nocturnal void/night) were included and filled the Overactive Bladder questionnaire, Nocturia Quality of Life, Incontinence Questionnaire - Male Lower Urinary Tract Symptoms (male), International Consultation on Incontinence Questionnaire - Female Lower Urinary Tract Symptoms (female) and 3-day frequency-volume chart. Patients were divided into three groups according to the severity of nocturia: group 1 consisted of patients with mild (1-2 voids/night), group 2 with moderate (3-4 voids/night) and group 3 with severe nocturia (>4 voids/night). Comparative analysis was performed between groups, and P < .05 was deemed as statistically significant.

RESULTS

About 68.1%, 64.1% and 8.7% of the patients had nocturnal polyuria (NP), reduced bladder capacity and global polyuria, respectively. 42.7% of the patients had mixed nocturia. 6.1% of the patients did not comply with the aforementioned subtypes and defined as isolated nocturia. Regarding the severity of nocturia, 155 (41%) patients had mild, 167 (45%) patients had moderate and 57 (15%) patients had severe nocturia. Increased nocturia severity was related with decreased quality of life; higher age, urinary tract symptom scores, nocturnal urine volume, evening fluid consumption and beta-blocker medication rates. Increased nocturia severity was also associated with higher NP, global polyuria and reduced bladder capacity rates.

CONCLUSIONS

Nocturia mechanisms may vary between mild and moderate to severe nocturia groups according to the present study. Nocturia grading with identification of subtypes may help for better standardisation of the diagnostic and treatment approaches as well as for the design of future clinical trials.