Socioeconomic burden of urinary incontinence with focus on overactive bladder and tolterodine treatment

The socioeconomic burden of a disease or condition is related to its epidem iology, impact on health-related quality of life, and economic costs. This review examines the relevant literature on urinary incontinence (UI) with f ocus on overactive bladder in adults. The prevalence of UI has been reporte d in 2-55 % of community-dwelling adults, with symptoms of urge incontinenc e accounting for 6-33 % of the total. Wide variations in prevalence rates a re largely due to differences in population characteristics and the methodo logy and definitions used in the investigations. Women have higher prevalen ce rates than men, and symptoms of urge incontinence increase with age. Ove rall, the worldwide socioeconomic burden of these conditions is substantial . Societal costs of UI were estimated to be $26 billion in 1995 US dollars, including close to $1 billion in indirect costs. Health-related quality of life (HRQoL) is significantly diminished and is influenced by symptom seve rity and how bothered individuals are by their symptoms. Urge incontinence appears to be associated with more distress or impairments than stress inco ntinence. Few pharmacological trials have measured costs and HRQoL. Recent results from 10-12 week trials in overactive bladder patients demonstrated improvements in HRQoL subsequent to treatment with tolterodine. An economic model estimated costs per quality-adjusted life years for tolterodine trea tment as within generally acceptable limits. In a cost-effectiveness analys is, marginal costs for tolterodine treatment were within a range that indiv iduals with UI were willing to pay for a 25-50 % reduction in symptoms.