Adherence to professional society guidelines among women with stress or mixed urinary incontinence

Abstract

Aims The objective of this analysis was to describe longitudinal adherence with recommended urinary incontinence (UI) evaluation and treatment guidelines over a 2‐year period in patients newly diagnosed with stress (SUI) or mixed UI (MUI), and average 2‐year cost associated with initial treatment. Methods A retrospective claims analysis using the IBM MarketScan database was conducted. Women diagnosed with SUI/MUI between July 1, 2014 and June 30, 2016 were identified using the International Classification of Diseases (ICD) 9 and 10 codes for SUI or MUI. Newly diagnosed SUI/MUI patients who did not have a UI‐related diagnosis for at least 1 year before their index date were assessed. Results 103 813 patients with newly diagnosed SUI or MUI were identified. Of those, 96.15% (99 821/103 813) received an initial evaluation in accordance with professional guidelines (e.g., patient history, physical examination, urinalysis). Only 6.8% (5086/74 925) and 7.7% (2229/28 888) of patients with SUI and MUI, respectively, received a first‐line behavioral treatment (e.g., pelvic floor muscle exercises, bladder training), according to guidelines. The 2‐year average UI‐related medical costs associated with guideline adherence for SUI were $5770.93 ± $9454.81 and for MUI, $4416.16 ± $7401.53. Nonadherence was observed in 59.2% (44 382/74 925) of SUI and 64.1% (18 530/28 888) of MUI patients. Two‐year average UI‐related medical costs for the nonadherent group were $8568.00 ± $11 275.52 for SUI and $6986.66 ± $10 765.55 for MUI, significantly more than the adherent group (p < 0.0001). Conclusion The majority of SUI or MUI patients do not receive a documented behavioral intervention as their first‐line treatment, which is a recommendation by professional society guidelines. This was found to affect the cost burden for payers; those that were nonadherent had significantly higher costs 2‐year postindex.

A Motion-based Device Urinary Incontinence Treatment: A Longitudinal Analysis at 18 and 24 Months

“…UI has negative impacts on physical and psychosocial health and conveys significant economic burden to individuals and society [ 2 – 6 ]. First-line care for all major subtypes of UI (stress, urgency, and mixed) includes pelvic floor muscle training (PFMT) [ 7 ], and yet only a small percentage of women undergo PFMT prior to advancing to medications, procedures, or surgical interventions to address their symptoms [ 8 ]. Many women do not engage in first-line care at all, instead receiving more advanced treatments such as medication or surgery as their first treatment [ 8 ].…”

“…First-line care for all major subtypes of UI (stress, urgency, and mixed) includes pelvic floor muscle training (PFMT) [ 7 ], and yet only a small percentage of women undergo PFMT prior to advancing to medications, procedures, or surgical interventions to address their symptoms [ 8 ]. Many women do not engage in first-line care at all, instead receiving more advanced treatments such as medication or surgery as their first treatment [ 8 ]. There are many explanations for this failure to utilize first-line care, including a lack of confidence in PFMT that has been expressed by clinicians, skepticism regarding efficacy by patients themselves, and difficulty accessing care owing to constraints of time, cost, or provider availability [ 9 – 11 ].…”

Real-world evidence from a digital health treatment program for female urinary incontinence: Outcomes analysis following user-centered product updates (Preprint)

“…Data suggests that 67% of women experience symptom improvement or resolution with PFMT [6]. Despite high UI prevalence and strong evidence to support behavioral interventions for UI, most women are untreated or undertreated for these conditions [7][8][9].…”

“The constant worry”: Urinary incontinence self‐management in rural women: A qualitative study

“…Further, when UI is reported to a provider, many do not receive appropriate treatment options. A recent retrospective analysis of nearly 104,000 medical claims from women diagnosed with stress UI or mixed UI found only 6.8% and 7.7% of women with stress UI and mixed UI, respectively, received treatment adherent to clinical guidelines (Pan et al, 2022). While the Women's Preventive Services Initiative (O'Reilly et al, 2018) recommends annual screenings for UI in women using a validated instrument, the American Academy of Family Physicians has expressed resistance to this recommendation, citing the paucity of research on the adverse effect of screening and the lack of knowledge regarding how or if early intervention improves outcomes (Shaughnessy, 2019).…”