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The "Costs" of Urinary Incontinence for Women

From the Departments of ¹Obstetrics, Gynecology, and Reproductive Sciences and ²Epidemiology and Biostatistics, University of California, San Francisco, San Francisco, California; ³University of Texas Health Science Center at San Antonio, Texas; ⁴Loyola University of Chicago, Maywood, Illinois; ⁵University of Alabama at Birmingham, Birmingham, Alabama; ⁶University of Iowa, Iowa City, Iowa; ⁷Department of Medicine, University of California, San Francisco; and ⁸San Francisco Veterans Affairs Medical Center, San Francisco, California.

OBJECTIVE: To estimate costs of routine care for female urinary incontinence, health-related quality of life, and willingness to pay for incontinence improvement.

METHODS: In a cross-sectional study at 5 U.S. sites, 293 incontinent women quantified supplies, laundry, and dry cleaning specifically for incontinence. Costs were calculated by multiplying resources used by national resource costs and presented in 2005 United States dollars ($2005). Health-related quality of life was estimated with the Health Utilities Index. Participants estimated willingness to pay for 25–100% improvement in incontinence. Potential predictors of these outcomes were examined using multivariable linear regression.

RESULTS: Mean age was 56 ± 11 years; participants were racially diverse and had a broad range of incontinence severity. Nearly 90% reported incontinence-related costs. Median weekly cost (25%, 75% interquartile range) increased from $0.37 ($0, 4) for slight to $10.98 ($4, 21) for very severe incontinence. Costs increased with incontinence severity (P < .001). Costs were 2.4-fold higher for African American compared with white women (P < .001) and 65% higher for women with urge compared with those having stress incontinence (P < .001). More frequent incontinence was associated with lower Health Utilities Index score (mean 0.90 ± 0.11 for weekly and 0.81 ± 0.21 for daily incontinence; P = .02). Women were willing to pay a mean of $70 ± $64 per month for complete resolution of incontinence, and willingness to pay increased with income and greater expected benefit.

CONCLUSION: Women with severe urinary incontinence pay $900 annually for incontinence routine care, and incontinence is associated with a significant decrement in health-related quality of life. Effective incontinence treatment may decrease costs and improve quality of life.

LEVEL OF EVIDENCE: III

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