THE ECONOMIC BURDEN OF OVERACTIVEBLADDER IN THE UNITED STATES: A SYSTEMATIC REVIEW
L. STEWART1, S. SZABO1, D. WALKER 2, K. GOOCH 2;
1Broadstreet Heath Economics and Outcomes Res.,Vancouver, Canada, 2Astellas Pharma Global Dev., Inc,Northbrook, IL.
Introduction: Overactive bladder(OAB) is a highly prevalent condition affecting approximately 17% ofthe US population.1 The prevalence of OAB increases withage and is associated with an increased risk of comorbidities.Although economic data have been published, the study designs,populations, and cost drivers considered between studies have varied;and no overall synthesis of costs among those with OAB have beenpresented.
Objective: To synthesize estimates of all-causeand OAB-specific total direct and indirect costs among individualswith OAB in the US, from the published literature.
Methods:A systematic literature review was conducted using the MEDLINE andEMBASE databases from January 1, 2003 to October 31, 2016. The targetpopulation was adults (≥18 years) with idiopathic OAB or idiopathicurge UI from the US; populations with neurogenic OAB or stress UIwere excluded. Outcomes of interest included total all-cause directcosts (including medical and pharmacy costs); total OAB-specificdirect costs; the proportion of total costs attributable toOAB-specific costs; and total indirect (including absenteeism andpresenteeism) costs. Where available, estimates from OAB samples werecompared to estimates from non-OAB samples from the same studies.Data from independent subgroups were combined to estimate total costsper group per study, where necessary. Costs were inflated to 2016 USdollars (USD) using the medical component of the Consumer PriceIndex; and costs were compared according to the mean age andproportion male of the sample.
Results: Ten peer-reviewedpublications met the inclusion criteria; 9 retrospective claimsanalyses and 1 cross-sectional survey. Years of publication spannedfrom 2005 to 2016. From all included studies, the mean age of thesample ranged from 47 to 75 years, and the proportion male rangedfrom 15.7% to 74.3%; the majority of studies reported on populationswho were undergoing pharmacological treatment for OAB. Mean totalall-cause direct cost was reported by 9 studies, and ranged from$8,168.66 (from a highly selected sample of older adults undergoingcontinuous OAB pharmacotherapy) to $23,305.07 (from a large claimsdatabase analyses) per patient annually. Mean total OAB-specificcosts were reported in three of the nine studies, and ranged from$610.69 to $751.00. The proportion of total direct costs attributableto OAB-specific claims in those three studies ranged from 3.1% to5.5%. In the three studies reporting all-cause total direct costsfrom both OAB and non-OAB samples, managing patients with OAB cost anincremental 43% to 117% each year, compared to managing those withoutOAB. No clear trend was observed in estimates of direct costsaccording to the sample characteristics (age and sex) of the studiesincluded. Only one study estimated total annual indirect costs of OABat $11,113.48 per patient, using data from the 2011 US NationalHealth and Wellness Survey and median weekly income figures obtainedfrom the Bureau of Labor Statistics.
Conclusions: Theoverall economic burden of OAB includes the direct medical costs oftreating the condition and its related comorbidities; as well asindirect costs such as lost work productivity. From studies includingboth OAB and non-OAB samples, the incremental direct costs ofmanaging patients with OAB ranged from a 1.4- to more than 2-foldincrease, compared to managing those without OAB. Estimates ofindirect costs in OAB can be substantial, however, due to limitedstudies, additional assessments of the direct and indirect economicburden of OAB is warranted.
References: 1. Stewart W, VanRooyen J, Cundiff G, et al. Prevalence and burden of overactivebladder in the United States. World journal of urology.2003;20(6):327-336.