CLINICAL AND SOCIOECONOMIC RELEVANCE OF OVERACTIVE BLADDER FRANS M. J. DEBRUYNE AND JOHN P. F. A. HEESAKKERS P hysicians often fail to appreciate that overac- tive bladder (OAB) is a devastating condition that incurs substantial costs for individuals, soci- ety, and health care providers. 1,2 The OAB syn- drome has been defined by the International Con- tinence Society as a spectrum of symptoms in which incontinence may or may not overlap with urgency, frequency, and nocturia. 3 Slightly more women than men, but also children and especially the elderly, have this disorder. The OAB syndrome is not a disease endemic to a particular culture. Prevalence is fairly consistent across different countries, with rates ranging between 11% and 22% in France, Italy, Germany, Sweden, the United Kingdom, and Spain. Overall, OAB is estimated to affect approximately 17% of the adult population in Europe and the United States, 4,5 with worldwide prevalence estimated between 50 million and 100 million. 6 As high as these numbers are, they may represent a significant underestimation of individ- uals with OAB because relatively few patients with the disease seek treatment. In reality, OAB is prob- ably more prevalent than asthma and heart disease and nearly as prevalent as arthritis and chronic sinusitis. Most patients with OAB have symptoms of fre- quency and urgency; 50% have urge inconti- nence. 4 Where patients are on the spectrum of OAB may differentially affect how they view their condition and their decision to seek treatment. An elderly patient with occasional frequency and urge incontinence may accept these symptoms as nor- mal consequences of aging. A young adult, how- ever, may be devastated by the embarrassment of nocturia. Such are the intangible costs of OAB. More tangible, although still uncertain, are the costs of the significant comorbidities associated with OAB, which include increased risk of falls and hip fracture, urinary tract and skin infections, and sexual dysfunction. Many patients with OAB may be uncomfortable and silent, but not without psy- chological consequences. In the long term, depres- sion often occurs and quality of life is significantly impaired for patients with serious OAB symptoms, even in the absence of incontinence. Of the 33 million people in the United States with OAB, only 12 million are incontinent. 5 To estimate the economic costs of this disease, how- ever, we are forced to look at the costs of urinary incontinence alone. In US women, urinary incon- tinence accounts for more direct expenditures than breast cancer—the most common type of cancer in women—and direct costs similar to osteoporosis. 7 According to data from the National Overactive Bladder Evaluation (NOBLE) Program, 50% of the approximately 16.9% of women in the United States with OAB experience urinary incontinence. 8 Costs associated with treatment of stress inconti- nence alone, including the increasingly common tension-free vaginal tape procedure, represent 82% of treatment expenditures for all types of inconti- nence. Treatment, however, is only a part of the costs associated with urinary incontinence. Annual total costs, including treatment and diagnosis, absor- bent products, related medical conditions, assisted living or nursing home care, lost wages, and clean- ing expenses are estimated to range from $16 bil- lion to as high as $26 billion each year in the United States, depending on the age group stud- ied. 2,7 The costs of OAB may be on par with those for depression ($44 billion) 9 and Alzheimer dis- ease ($100 billion). 10 In 1995, annual costs per incontinent patient were estimated at $3565 in the United States. 11 In the United Kingdom, more of the National Health Service budget is spent on management of incontinence than on coronary care and cancer treatment combined. Approxi- mately 50% of the cost of management in UK nurs- ing homes is attributed to incontinence. Although staggering, these numbers still fail to convey the true economic and social burdens of the OAB syndrome. Even in Western Europe and the From the Department of Urology, University Medical Centre Nijmegen, Nijmegen, the Netherlands Reprint requests: Frans M. J. Debruyne, MD, PhD, University Medical Centre Nijmegen, Department of Urology– 426, PO Box 9101, 6500 HB Nijmegen, the Netherlands. E-mail: F.Debruyne@ uro.umcn.nl © 2004 ELSEVIER INC. UROLOGY 63 (3A): 42– 44, 2004 • 0090-4295/04/$30.00 42 ALL RIGHTS RESERVED doi:10.1016/j.urology.2003.12.001