title: Urinary incontinence management costs are reduced following Burch or sling surgery for stress incontinence.
abstract: OBJECTIVE
  The objective of the study was to estimate the effect of Burch and fascial sling surgery on out-of-pocket urinary incontinence (UI) management costs at 24 months postoperatively and identify predictors of change in cost among women enrolled in a randomized trial comparing these procedures.
  
  
  METHODS
  Resources used for UI management (supplies, laundry, dry cleaning) were self-reported by 491 women at baseline and 24 months after surgery, and total out-of-pocket costs for UI management (in 2012 US dollars) were estimated. Data from the 2 surgical groups were combined to examine the change in cost for UI management over 24 months. Univariate and bivariate changes in cost were analyzed using the Wilcoxon signed rank test. Predictors of change in cost were examined using multivariate mixed models.
  
  
  RESULTS
  At baseline mean (±SD) age of participants was 53 ± 10 years, and the frequency of weekly UI episodes was 23 ± 21. Weekly UI episodes decreased by 86% at 24 months (P < .001). The mean weekly cost was $16.60 ± $27.00 (median $9.39) at baseline and $4.57 ± $15.00 (median $0.10) at 24 months (P < .001), a decrease of 72%. In multivariate analyses, cost decreased by $3.38 ± $0.77 per week for each decrease of 1 UI episode per day (P < .001) and was strongly associated with greater improvement in Urogenital Distress Inventory and Incontinence Impact Questionnaire scores (P < .001) and decreased 24-hour pad weight (P < .02).
  
  
  CONCLUSIONS
  Following Burch or fascial sling surgery, the UI management cost at 24 months decreased by 72% ($625 per woman per year) and was strongly associated with decreasing UI frequency. Reduced out-of-pocket expenses may be a benefit of these established urinary incontinence procedures.
authors.affiliation: Departments of Obstetrics, Gynecology, and Reproductive Sciences, Epidemiology and Biostatistics, and Urology, University of California, San Francisco, School of Medicine, San Francisco, CA; San Francisco Veterans Affairs Medical Center, San Francisco, CA. Electronic address: subakl@obgyn.ucsf.edu.
authors.forename: Leslee L
authors.initials: LL
authors.lastname: Subak
authors.affiliation: Geriatric Research, Education, and Clinical Center, Birmingham Veterans Affairs Medical Center, and University of Alabama at Birmingham, Birmingham, AL.
authors.forename: Patricia S
authors.initials: PS
authors.lastname: Goode
authors.affiliation: Departments of Obstetrics and Gynecology and Urology, Loyola University Chicago School of Medicine, Chicago, IL.
authors.forename: Linda
authors.initials: L
authors.lastname: Brubaker
authors.affiliation: National Institute of Diabetes and Digestive and Kidney Diseases, Bethesda, MD.
authors.forename: John W
authors.initials: JW
authors.lastname: Kusek
authors.affiliation: Departments of Obstetrics, Gynecology, and Reproductive Sciences, Epidemiology and Biostatistics, and Urology, University of California, San Francisco, School of Medicine, San Francisco, CA.
authors.forename: Michael
authors.initials: M
authors.lastname: Schembri
authors.affiliation: Department of Reproductive Medicine, University of California, San Diego, School of Medicine, San Diego, CA.
authors.forename: Emily S
authors.initials: ES
authors.lastname: Lukacz
authors.affiliation: Department of Urology, University of Texas Health Science Center at San Antonio, San Antonio, TX.
authors.forename: Stephen R
authors.initials: SR
authors.lastname: Kraus
authors.affiliation: Department of Urology, University of Maryland School of Medicine, Baltimore, MD.
authors.forename: Toby C
authors.initials: TC
authors.lastname: Chai
authors.affiliation: Department of Obstetrics and Gynecology, University of Utah School of Medicine, Salt Lake City, UT.
authors.forename: Peggy
authors.initials: P
authors.lastname: Norton
authors.affiliation: New England Research Institutes, Watertown, MA.
authors.forename: Sharon L
authors.initials: SL
authors.lastname: Tennstedt
mesh_terms: D041382:Diapers, Adult / Q000191:economics; D005260:Female; D006801:Humans; D016496:Incontinence Pads / Q000191:economics; D007846:Laundering / Q000191:economics; D052576:Menstrual Hygiene Products / Q000191:economics; D008875:Middle Aged; D015999:Multivariate Analysis; D011184:Postoperative Period; D053825:Suburethral Slings; D011795:Surveys and Questionnaires; D014481:United States; D014550:Urinary Incontinence, Stress / Q000191:economics* / Q000601:surgery*; D013520:Urologic Surgical Procedures
keywords: cost analysis; costs; urinary incontinence; urinary incontinence costs