Costs of urinary incontinence and overactive bladder in the United States: a comparative study

Hu, Teh-wei; Wagner, Todd H.; Bentkover, Judith D.; LeBlanc, Kristi; Zhou, Steve Z; Hunt, Timothy

doi:10.1016/j.urology.2003.10.037

Cited by 388 publications

(240 citation statements)

References 10 publications

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“…Overactive urinary bladder and urinary incontinence is a significant health issue occurring in about 51 million (ϳ17%) of the United States population (1), frequently occurring as a secondary consequence of conditions such as diabetes mellitus, stroke, and spinal cord injury. Urge incontinence is caused by overactivity of the urinary bladder smooth muscle (UBSM), 1 often a result of partial urethral outlet obstruction that can occur during prostate hypertrophy.…”

mentioning

confidence: 99%

Overactive Bladder and Incontinence in the Absence of the BK Large Conductance Ca2+-activated K+ Channel

Meredith

Thorneloe

Werner

et al. 2004

Journal of Biological Chemistry

310

363

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BK large conductance voltage-and calcium-activated potassium channels respond to elevations in intracellular calcium and membrane potential depolarization, braking excitability of smooth muscle. BK channels are thought to have a particularly prominent role in urinary bladder smooth muscle function and therefore are candidate targets for overactive bladder therapy. To address the role of the BK channel in urinary bladder function, the gene mSlo1 for the pore-forming subunit of the BK channel was deleted. Slo ؊/؊ mice were viable but exhibited moderate ataxia. Urinary bladder smooth muscle cells of Slo ؊/؊ mice lacked calcium-and voltageactivated BK currents, whereas local calcium transients ("calcium sparks") and voltage-dependent potassium currents were unaffected. In the absence of BK channels, urinary bladder spontaneous and nerve-evoked contractions were greatly enhanced. Consistent with increased urinary bladder contractility caused by the absence of BK currents, Slo ؊/؊ mice demonstrate a marked elevation in urination frequency. These results reveal a central role for BK channels in urinary bladder function and indicate that BK channel dysfunction leads to overactive bladder and urinary incontinence.Overactive urinary bladder and urinary incontinence is a significant health issue occurring in about 51 million (ϳ17%) of the United States population (1), frequently occurring as a secondary consequence of conditions such as diabetes mellitus, stroke, and spinal cord injury. Urge incontinence is caused by overactivity of the urinary bladder smooth muscle (UBSM), 1 often a result of partial urethral outlet obstruction that can occur during prostate hypertrophy. Currently there is a lack of effective therapeutic agents to control urinary bladder function. Antimuscarinic agents, which impair UBSM contraction, are used to treat urinary incontinence but have limited effectiveness and undesirable side effects. More recently, potassium channel opening drugs have been explored as therapeutic agents for urinary incontinence (2-6).BK potassium channels regulate membrane potential and repolarization of UBSM action potentials (7-8). UBSM BK channels are activated by membrane potential depolarization and calcium influx through voltage-dependent calcium channels that occur during the action potential (9). UBSM BK channels are also activated by local intracellular calcium release through ryanodine receptors (calcium sparks) (10). Specific inhibition of BK channels by iberiotoxin (IBTX) causes a pronounced elevation in bladder contractility (8,(11)(12). Deletion of the smooth muscle-specific, modulatory ␤1 subunit decreases the apparent voltage-and calcium-sensitivity of UBSM BK channels, leading to an enhancement of phasic contractility (12). These studies point to a pivotal role of the BK channel in urinary bladder function. EXPERIMENTAL PROCEDURESGeneration of Slo Ϫ/Ϫ Mice-mSlo1 genomic clones were isolated from a 129/SvJ BAC library (Incyte Genomics) using an ϳ1.6-kb EcoRV/XhoI cDNA probe fragment. A 7.8-kb SalI/BamHI geno...

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confidence: 99%

Overactive Bladder and Incontinence in the Absence of the BK Large Conductance Ca2+-activated K+ Channel

Meredith

Thorneloe

Werner

et al. 2004

Journal of Biological Chemistry

310

363

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“…9 The economic burden of OAB to the Canadian economy is substantial and includes prescription drugs, medical equipment, therapies, physician time, and lost productivity. 10 The estimated financial impact of OAB on healthcare expenditure in the United States is about $9 billion. The direct cost of OAB in Canada is about $175 million; this figure is increased to $352 million when accounting for urgency urinary incontinence.…”

Section: Introductionmentioning

confidence: 99%

“…4 Several approved medications are used in management of OAB in Canada including: oxybutynin chloride, tolterodine tartrate, trospium chloride, solifenacin succinate, darifenacin hydrobromide, and fesoterodine fumarate. 10 These anticholinergic drugs are intended to block the acetylcholine transmitter in the bladder through the muscarinic receptor subtypes in the detrusor muscle. [13][14][15] This inhibition disrupts the frequent spontaneous contractions that occur during the bladder filling.…”

Section: Introductionmentioning

confidence: 99%

Economic evaluation of sacral neuromodulation in overactive bladder: A Canadian perspective

Hassouna

Sadri

2015

CUAJ

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Introduction: Refractory overactive bladder (OAB) with urge incontinence is an underdiagnosed condition with substantial burden on the healthcare system and diminished patient's quality-of-life. Many patients will fail conservative treatment with optimized medical-therapy (OMT) and may benefit from minimally invasive procedures, including sacral-neuromodulation (SNM) or botulinum-toxin (BonT-A). The goal of this study was to estimate the costefectiveness of SNM vs. OMT and BonT-A as important parameters from coverage and access to a therapy. Methods: A Markov model with Monte-Carlo simulation was used to assess the incremental cost effectiveness ratio (ICER) of SNM vs. BonT-A and OMT both in deterministic and probabilistic analysis from a provincial payer perspective over a 10-year time horizon with 9-month Markov-cycles. Clinical data, healthcare resource utilization, and utility scores were acquired from recent publications and an expert panel of 7 surgeons. Cost data (2014-Dollars) were derived from provincial health insurance policy, drug benefit formulary, and hospital data. All cost and outcomes were discounted at a 3% rate. Results: The annual (year 1-10) incremental quality-adjusted life years for SNM vs. BonT-A was 0.05 to 0.51 and SNM vs. OMT was 0.19 to 1.76. The annual incremental cost of SNM vs. BonT-A was $7237 in year 1 and -$9402 in year 10 and was between $8878 and -$11 447 vs. OMT. In the base-case deterministic analysis, the ICER for SNM vs. BonT-A and OMT were within the acceptable range ($44 837 and $15 130, respectively) at the second year of therapy, and SNM was dominant in consequent years. In the basecase analysis the probability of ICER being below the acceptability curve (willingness-to-pay $50 000) was >99% for SNM vs. BonT-A at year 3 and >95% for OMT at year 2. Conclusion: SNM is a cost-effective treatment option to manage patients with refractory OAB when compared to either BonT-A or OMT. From a Canadian payers' perspective, SNM may be considered a first-line treatment option in management of patients with OAB with superior long-term outcomes. Similar to all economic analysis, this study has limitations which are based on the assumptions of the used model.

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“…Frequent urination or urgency to void the bladder can increase the risk of falls by 26% and bone fracture by as much as 34% [2]. Up to 50% of homebound and nursing home residents are incontinent, with an estimated societal cost of 12.6 billion dollars in the US annually [3].…”

Section: Introductionmentioning

confidence: 99%

Prototype Ultra Wideband Radar System for Bladder Monitoring Applications

O’Halloran¹,

Morgan²,

Flores-Tapia³

et al. 2012

PIER C

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Abstract-The aim of this study is to address the management of urinary problems by detecting changes in the volume of urine within the human bladder using low cost, low power, wearable Ultra Wideband (UWB) sensors and signal processing techniques. The paper describes experiments on the classification of six three-layer dielectrically representative bladder phantoms, mimicking a range of muscle and bladder wall-to-wall distances. The process involves the illumination of the bladder with a UWB pulse. Due to the dielectric contrast between urine and bladder wall tissue at microwave frequencies, an electromagnetic reflection is generated at both the anterior and posterior bladder wall. These reflections are recorded, the salient features are extracted and processed by a classification algorithm to estimate the volume of urine present in the bladder. To evaluate the prototype system, a number of physical bladder phantoms were constructed, each mimicking bladders of different volumes. Principal Component Analysis (PCA) was applied and the processed features were classified by a K-Nearest Neighbour learning algorithm to estimate the state of the bladder (small, medium or full). The paper describes the bladder phantom prototype systems and the experimental setup. Results illustrate detection of phantom bladder states with an accuracy of up to 91%.

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Costs of urinary incontinence and overactive bladder in the United States: a comparative study

Cited by 388 publications

References 10 publications

Overactive Bladder and Incontinence in the Absence of the BK Large Conductance Ca2+-activated K+ Channel

Overactive Bladder and Incontinence in the Absence of the BK Large Conductance Ca2+-activated K+ Channel

Economic evaluation of sacral neuromodulation in overactive bladder: A Canadian perspective

Prototype Ultra Wideband Radar System for Bladder Monitoring Applications

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