Health-related consequences of overactive bladder.
OBJECTIVE
Overactive bladder (OAB) is a condition of urgency, with or without urge incontinence, usually with frequency and nocturia. This study assesses whether people with OAB are at greater risk for urinary tract infections (UTIs), falls and injuries, and increased number of visits to the doctor compared to age- and gender-matched controls. The study also estimates costs associated with these health-related consequences.


METHODS
A US representative telephone survey under the National Overactive Bladder Evaluation (NOBLE) Program was conducted with 5204 English-speaking adults older than 18 years. The survey asked respondents about bladder symptoms. Based on the telephone survey, 865 symptom-identified OAB cases and 903 age- and gender-matched controls were sent a postal questionnaire. A total of 397 cases and 522 controls returned the questionnaires. Nonrespondent cases and controls did not differ with regard to age, gender, educational status, diabetes, congestive heart failure, and self-rated health status. Regression analyses were conducted to assess the effect of OAB on health-related consequences, controlling for age, gender, race, education, marital status, number of previous births, self-reported health status, diabetes, and congestive heart failure.


RESULTS
People with OAB reported 0.84 (20%) more visits to the physician (P < .05) and 0.21 (138%) more UTIs in the last year than people without OAB (P < .001). Overactive bladder cases also had over twice the odds of being injured in a fall than people without OAB (odds ratio = 2.26; 95% confidence interval 1.46, 3.51). Consistent with having more falls, OAB cases had an increased risk of bone fracture (P < .1). This effect, however, was not statistically significant (at alpha level 0.05) due to the limited sample size. The estimated cost of UTIs associated with OAB was approximately $1.37 billion US dollars in year 2000. The cost of falls without bone fracture due to OAB was $55 million. Falls with bone fracture accounted for approximately $386 million; however, further research with a larger sample is needed to accurately estimate these costs.


CONCLUSIONS
People with OAB self-report significantly more UTIs and a greater risk of being injured in a fall. Given the large prevalence of UTIs and concerns of overprescribing antibiotics, these results are important for health plans and policy makers. In addition, people with OAB visit their physicians more often than people without OAB. These consequences entail significant economic costs, of which a large percentage will be incurred by health plans. To the extent that OAB causes these consequences, there may be significant savings from effectively treating OAB.
Wagner
Todd H
TH
Health Economics Resource Center, Department of Veterans Affairs, Stanford University School of Medicine, Menlo Park, California, USA.
Hu
Teh-wei
TW
Bentkover
Judith
J
LeBlanc
Kristi
K
Stewart
Walter
W
Corey
Ron
R
Zhou
Zhiyuan
Z
Hunt
Timothy
T
D000058:Accidental Falls / Q000191:economics / Q000706:statistics & numerical data; D000328:Adult; D016022:Case-Control Studies; D005260:Female; D050723:Fractures, Bone / Q000150:complications / Q000191:economics / Q000453:epidemiology; D017048:Health Care Costs; D019538:Health Care Surveys; D006801:Humans; D008297:Male; D008875:Middle Aged; D009819:Office Visits / Q000706:statistics & numerical data; D012307:Risk Factors; D014481:United States / Q000453:epidemiology; D001745:Urinary Bladder Diseases / Q000150:complications / Q000191:economics / Q000453:epidemiology; D014552:Urinary Tract Infections / Q000150:complications / Q000191:economics / Q000453:epidemiology; D014555:Urination Disorders / Q000150:complications* / Q000191:economics / Q000453:epidemiology