A study was conducted to evaluate the clinical and economic burden of overactive bladder (OAB) among patients <60 years of
age in a managed care population, especially with regard to the prevalence of related comorbidities and associated annual
medical costs.
INTRODUCTION
An estimated 33.3 million adults in the United States suffer from OAB with an associated cost of more than $12 billion annually.1,2 The additional costs related to treating OAB comorbidities such as falls and fractures, depression, urinary tract infections
(UTIs), skin infections, and vulvovaginitis are substantial.3 OAB is often considered a condition of the elderly and few studies have examined the clinical and economic impact of the
condition in younger individuals.4–10
METHODS
Patients with OAB between the ages of 18 and 59 years during January 1 through June 30, 2002, were identified through a retrospective
analysis of healthcare claims data of 2.7 million members from a US managed care organization and were followed for 1 year.
A random sample of controls without OAB was matched 1:1 to the study group on demographics and on relevant clinical conditions
using propensity score matching.
The primary outcome measure was the proportion of patients with a primary or secondary diagnosis of the following comorbidities:
falls and fractures, depression, UTIs, skin infections, and vulvovaginitis. The likelihood of these comorbidities in the OAB
versus control group was calculated as odds ratios.
Logistic regression was used to compare OAB patients with controls, adjusting for additional clinical characteristics such
as neurologic conditions, diuretic use, inappropriate use of select medications from the Beers criteria,11 prostatic hyperplasia, and bladder neoplasm that could increase the likelihood of studied comorbidities.
Mean annual submitted medical charges were calculated for each comorbidity among the subset of members who incurred medical
charges for that condition.
RESULTS
Figure 1: Prevalence of studied comorbidities
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A total of 2,750 patients with OAB, along with 2,750 matched controls, were identified: 73.3% were female and the mean age
was 45.09.9 years. The prevalence of studied comorbidities in non-elderly patients with OAB was higher (P<.0001) compared with matched controls (Figure 1). Patients with OAB were significantly more likely than controls to have each of the studied comorbidities after adjustment
for contributing factors. The odds ratios of patients with OAB having the comorbidities compared with controls (P<.0001 for all comparisons) were: UTIs, 4.7; vulvovaginitis, 2.9; depression, 2.5; skin infections, 2.2; and falls and fractures,
1.6. Overall, patients with OAB were 2.8 times more likely (P<.0001) to have at least 1 of these comorbid conditions compared with controls.
Figure 2 : Mean annual medical charges for studied comorbidities
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Among study subjects who incurred medical charges for the studied comorbidities, the mean annual charges for each comorbid
condition were higher among patients with OAB, with skin infections causing the greatest additional costs compared with controls,
followed by UTIs, any comorbidity, depression, falls and fractures, and vulvovaginitis (Figure 2).
Discussion
In this non-elderly population with OAB, falls and fractures were the most frequent of the studied comorbidities, with a similar
prevalence to that observed in another study in which the average age of the patients with OAB was 69.0 years, thus representing
an important topic for education and counseling for even the non-elderly patients with OAB.12The magnitude of difference in medical changes related to skin infections and UTI, which were greater among patients with
OAB compared with controls, suggests that these conditions may be more difficult to treat among younger individuals with OAB.
Further investigation is needed to evaluate the impact of pharmacolgic therapy for OAB on the prevalence and cost of managing
the studied comorbid conditions.
CONCLUSIONS
This study confirms that OAB does occur in the non-elderly adult population and that the potential economic impact can be
significant.
The results support previous findings demonstrating the association of OAB with falls and fractures, depression, UTI, skin
infections, and vulvovaginitis.
These comorbid conditions are prevalent in non-elderly patients with OAB, which may lead to significant increases in health-care
utilization by this population.
Clinicians and health-care payors should not overlook the importance of OAB and its associated comorbidities in non-elderly
adults and should appreciate the potential importance of appropriate diagnosis, treatment, and follow-up.
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