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High Costs of Urinary Incontinence Among Women Electing Surgery to Treat Stress Incontinence

From the Departments of ¹Obstetrics, Gynecology & Reproductive Sciences and ²Epidemiology & Biostatistics, University of California, San Francisco, San Francisco, California; ³Departments of Obstetrics & Gynecology and Urology, Loyola University, Chicago, Illinois; ⁴Department of Urology, University of Maryland, Baltimore, Maryland; ⁵Department of Urology, William Beaumont Hospital, Royal Oak, Michigan; ⁶Geriatric Research, Education and Clinical Center, Birmingham Veterans Affairs Medical Center, and University of Alabama at Birmingham, Birmingham, Alabama; ⁷Department of Urology, University of Texas Health Science Center at San Antonio, San Antonio, Texas; ⁸National Institute of Diabetes and Digestive and Kidney Diseases, Bethesda, Maryland; ⁹Department of Urology, University of Pittsburgh, Pittsburgh, Pennsylvania; ¹⁰Department of Reproductive Medicine, University of California, San Diego, San Diego, California; ¹¹Department of Obstetrics and Gynecology, University of Utah, Salt Lake City, Utah; and ¹²New England Research Institutes, Watertown, Massachusetts.

OBJECTIVE: To estimate costs for incontinence management, health-related quality of life, and willingness to pay for incontinence improvement in women electing surgery for stress urinary incontinence.

METHODS: A total of 655 incontinent women enrolled in the Stress Incontinence Surgical Treatment Efficacy Trial, a randomized surgical trial. Baseline out-of-pocket costs for incontinence management were calculated by multiplying self-report of resources used (supplies, laundry, dry cleaning) by national resource costs ($2006). Health-related quality of life was estimated with the Health Utilities Index Mark 3. Participants estimated willingness to pay for 100% improvement in incontinence. Potential predictors of these outcomes were examined by using multivariable linear regression.

RESULTS: Mean age was 52±10 years, and mean number of weekly incontinence episodes was 22±21. Mean and median (25%, 75% interquartile range) estimated personal costs for incontinence management among all women were $14±$24 and $8 (interquartile range $3, $18) per week, and 617 (94%) women reported any cost. Costs increased significantly with incontinence frequency and mixed compared with stress incontinence. The mean and median Health Utilities Index Mark 3 scores were 0.73±0.25 and 0.84 (interquartile range 0.63, 0.92). Women were willing to pay a mean of $118±$132 per month for complete resolution of incontinence, and willingness to pay increased significantly with greater expected incontinence improvement, household income, and incontinent episode frequency.

CONCLUSION: Urinary incontinence is associated with substantial costs. Women spent nearly $750 per year out of pocket for incontinence management, had a significant decrement in quality of life, and were willing to pay nearly $1,400 per year for cure.

LEVEL OF EVIDENCE: III