Social, economic, and health utility considerations in the treatment of overactive bladder

Emilio Sacco, Daniele Tienforti, Alessandro D'Addessi, Francesco Pinto, Marco Racioppi, Angelo Totaro, Daniele D'Agostino, Francesco Marangi, Pierfrancesco Bassi, Emilio Sacco, Daniele Tienforti, Alessandro D'Addessi, Francesco Pinto, Marco Racioppi, Angelo Totaro, Daniele D'Agostino, Francesco Marangi, Pierfrancesco Bassi

Abstract

Overactive bladder (OAB) is a highly prevalent urinary syndrome with a profound impact on quality of life (QoL) of affected patients and their family because of its adverse effects on social, sexual, interpersonal, and professional function. Cost-of-illness analyses showed the huge economic burden related to OAB for patients, public healthcare systems, and society, secondary to both direct and indirect costs; however, intangible costs related to QoL impact are usually omitted from these analyses. Recently many novel treatment modalities have been introduced and the need to apply the modern methodology of health technology assessment to these treatment strategies was immediately clear in order to evaluate objectively their value in term of both improvement in length/quality of life and costs. Health utilities are instruments that allow a measurement of QoL and its integration in the economic evaluation using the quality-adjusted life-years model and cost-utility analysis. The development of suitable instruments for quantifying utility in the specific group of OAB patients is vitally important to extend the application of cost-utility analysis in OAB and to guide healthcare resources allocation for this disorder. Studies are required to define the cost-effectiveness of available pharmacological and nonpharmacological therapy options for this disorder.

Keywords: burden; cost-utility; health utility; overactive bladder.

Figures

Figure 1
Figure 1
Results of SF-36: QoL scores of a Swedish cohort of OAB patients compared to normalized scores from the general population, controlled for age and sex, but not for comorbidity. All domains are significantly lower than the normal (P < 0.001). For all scales the mean (SD) score in the general population is standardized to 50. Reproduced with permission from Kobelt G, Kirchberger I, Malone-Lee J. Quality-of-life aspects of the overactive bladder and the effect of treatment with tolterodine. BJU Int. 1999;83:583–590. Copyright © 1999 Wiley-Blackwell.
Figure 2
Figure 2
The overall estimated annual costs ($9 billion – 2000 US$) associated with OAB for patients in the community setting of United States. *Includes UTI, falls, broken bones, additional nursing home admissions, longer hospital stays, and skin conditions. Drawn from data of Hu et al.
Figure 3
Figure 3
Direct versus indirect methods of utility elicitation. Reproduced from Arnold D, Girling A, Stevens A, Lilford R. Comparison of direct and indirect methods of estimating health state utilities for resource allocation: review and empirical analysis. BMJ. 2009;339:b2688. Copyright © 2009 with permission from BMJ Publishing Group Ltd.
Figure 4
Figure 4
Heath-related utility scores based on the mean EQ5Dindex, in a patients population with OAB symptoms and continence/incontinence/stress incontinence. Reproduced with permission from Currie CJ, Mcewan P, Poole CD, Odeyemi IA, Datta SN, Morgan CL. The impact of the overactive bladder on health-related utility and quality of life. BJU Int. 2006;97:1267–1272. Copyright © 2006 Wiley-Blackwell.

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