Global perspective of treatment failures

Abstract

SECTION 1: CHALLENGES IN OAB-REVIEW S170Cite as: Can Urol Assoc J 2013;7(9-10):S170-1. http://dx.doi.org/10.5489/cuaj.1613 Published online October 9, 2013. AbstractOveractive bladder (OAB) is a highly prevalent condition, affecting approximately 18% of adult Canadians. The impact of OAB is substantial, negatively affecting quality of life, sexuality and work productivity. Furthermore, patients with OAB are at increased risk of several other important comorbidities, including mood and anxiety disorders. Despite widespread availability of efficacious treatment, research has shown that OAB remains underdiagnosed and undertreated. OAB: PrevalenceThe current definition of overactive bladder (OAB) is "urgency, with or without urge incontinence, usually with frequency and nocturia." 1 Using this definition, the estimated prevalence of OAB in Canada is approximately 18%. 2,3 ImpactThe impact of OAB on a patient's quality of life is substantial. Using the 36-Item Short-Form Health Survey (SF-36), research has demonstrated that the decrements in social and functional domains associated with OAB are more substantial than those of diabetes when compared to normal, healthy individuals (Fig. 1). 4,5 The Epidemiology of Lower Urinary Tract Symptoms (EpiLUTS) survey, 6 which consisted of a battery of tests for OAB and lower urinary tract symptoms (LUTS), identified more than 7000 individuals with OAB in the United Kingdom, Sweden and the United States. Of the American respondents, 68% of women and 60% of men were bothered at least somewhat by their OAB, with the most bothersome symptoms reported to be urgency, urgency urinary incontinence and nocturia. These patients had low scores with respect to health-related quality of life, anxiety and depression. 6 The burden of OAB also appears to extend beyond the bladder, as individuals with OAB are significantly more likely to have comorbid chronic conditions than individuals without OAB. 7 The EPIC study, which was a cross-sectional, population-based survey of almost 20 000 adults in Canada, Germany, Italy, Sweden and the United Kingdom, showed that obesity, hypertension, depression, asthma, diabetes, chronic constipation and neurologic conditions (e.g., multiple sclerosis, stroke, Parkinsonism) were significantly more common among those with OAB than those without. 7Other researchers have shown that individuals with OAB, when compared to those without OAB or with minimal symptoms, have decreased sexual activity and sexual enjoyment, 8,9 and that OAB is associated with a higher risk of work absenteeism, work disability and higher rates of unemployment.10,11 The impact of OAB on work parameters is similar to that of rheumatoid arthritis and asthma. 11In terms of financial impact, a 2010 American study estimated that the total annual cost of OAB in that country was over $65 billion in the year 2007, with costs projected to reach $82.6 billion in 2020.12 Importantly, the costs of pharmacologic therapy represent only a small fraction of total costs associated with OAB. 12 Current shortc...

Real-world persistence and adherence to oral antimuscarinics and mirabegron in patients with overactive bladder (OAB): a systematic literature review

“… 5 6 While the cost of pharmaceutical treatment represents only a small fraction of the total therapy cost, the provision of containment products (eg, pads), treatment for clinical depression, nursing home stays and loss of productivity due to work absenteeism are the main cost drivers in OAB. 7 8 For example, the total annual cost of OAB was estimated to be US$24.9 billion in the USA in 2007 9 and €9.7 billion across five European countries (Germany, Italy, Spain, Sweden and the UK) and Canada in 2005. 8 …”