Decrease in Urinary Incontinence Management Costs in Women Enrolled in a Clinical Trial of Weight Loss to Treat Urinary Incontinence

Abstract

Direct costs for management of urinary incontinence (UI) among middle-aged and older women exceed $20 billion per year in the United States. Greater than 50% of the costs of managing incontinence are due to routine use of resources used for incontinence management, such as absorbent pads, protection, and laundry. A number of studies have shown that increased frequency of UI is associated with higher incontinence management costs. It is not known whether successful treatment of incontinence would decrease the costs of management. The present study was a secondary analysis of a previously published randomized clinical trial that demonstrated the efficacy of an 18-month weight loss and maintenance program among obese and overweight women with UI. The aim of this study was to estimate the effect of decreased frequency of incontinence on UI management costs among women enrolled in that trial and to identify factors that may be predictive for changes in cost. A total of 338 obese and overweight women with 10 or more weekly episodes of UI at baseline were randomized to treatment with either the weight loss intervention program or a structured education program. Self-reported use of resources in a typical week for incontinence management (including pads, additional laundry, and dry cleaning) was assessed. Mean direct costs of UI management were calculated by multiplying units of resources used by the mean national resource costs per unit presented in 2006 US dollars. The effects of change in incontinence frequency on cost were examined by combining randomized groups. Generalized estimating equations were used to examine possible predictors of change in cost, adjusting for factors associated with change in cost that were identified in univariable analyses. The frequency of incontinent episodes was assessed at 6- and 18-month follow-up in both groups. Data were expressed as mean ± SD. At baseline, mean age of the subjects was 53 ± 10 years, weight was 97 ± 17 kg, and weekly UI frequency was 24 ± 18. Urinary incontinence frequency was decreased by 37% at 6 months and by 60% at 18 months (both P < 0.001). In multivariable models, adjusted mean cost at baseline was $7.76 ± $14 per week, and costs increased significantly with greater frequency of incontinence. Total mean management costs, adjusted for clinical site, were reduced by 54% at 6 months and 81% at 18 months (both P < 0.001). In the adjusted data, decreased costs were independently associated with weight loss; for every decrease of 7 total UI episodes per week, costs were decreased by 23%, and for every 5-kg decrease in weight, weekly costs decreased 21% (both P < 0.001). These findings show that among overweight and obese women enrolled in a weight loss program for UI, there is a substantial decrease in incontinence management costs at 18 months that is independently associated with decreasing incontinence frequency.