Üriner İnkontinansın Hastalık Yükü ve Maliyeti

Üriner inkontinans (Üİ) fiziksel, ruhsal, sosyal ve ekonomik yönden tüm bireyleri olumsuz etkileyen bir sağlık sorunudur. Üİ görülme sıklığı %7-10 arasında değişmektedir. Üİ birey, aile, toplum ve sağlık hizmetleri üzerinde ciddi ekonomik yük oluşturmaktadır. Üİ ekonomik yükünün belirlenmesinde hastalık yükü önemli bir parametre olup, sıklıkla Kaliteye Ayarlanmış Yaşam Yılı - KAYY (Quality Adjusted Life Years-QALY) kullanmaktadır. Üİ maliyetleri kullanılan ve kaybedilen tüm maliyetleri kapsamakta olup, doğrudan ve dolaylı maliyetleri içermektedir. Doğrudan maliyetler; tanı, tedavi, rutin bakım ve Üİ sonuç maliyetleri içermekt olup rutin bakım maliyetleri Üİ maliyetlerinin büyük bir bölümünü oluşturmaktadır. Dolaylı maliyetler Üİ ekonomik yükünün görünmeyen yüzü olup hesaplanması oldukça zordur ve doğrudan maliyetlerden daha büyük bir paya sahip olduğu düşünülmektedir. Türkiye’de Üİ’nin hastalık ve ekonomik yüküne ilişkin bir kayıt sistemi veya araştırmaya rastlanmamış olup veriler Sağlık Uygulama Tebliği (SUT) kapsamında belirtilen tanı ve tedavi maliyetleri ile sınırlıdır. Bu derlemede üriner inkontinansın hastalık yükü ve maliyetinin literatür doğrultusunda incelenerek mevcut durumu belirlenmiştir. Yapılan çalışmalar doğrultusunda Üİ’nin birey ve sağlık sistemi üzerinde ciddi ekonomik yük oluşturduğu, birinci basamak sağlık hizmetlerinin bu maliyeti azaltmada önemli bir güç olacağı belirtilmektedir. Ülkemizde de Üİ’nin ulusal düzeydeki ekonomik yükünün belirlenmesi, doğrudan ve dolaylı maliyetlerin açığa çıkarılması, kaynakların doğru ve etkin şekilde kullanılması, maliyet-etkin inkontinans yönetimi açısından oldukça önemlidir.

Anahtar Kelimeler:

Üriner inkontinans, hastalık yükü, maliyet

The Burden and Cost in Urinary Incontinence

Urinary incontinence (UI) is a health problem that affects all individuals physically, mentally, socially and economically. The prevalence of UI ranges between 5-70%. UI creates a serious economic burden on the individual, family, community, and health services. Disease burden is an important parameter in determining the economic burden of UI and often uses Quality Adjusted Life Years (QALY-a tool developed to evaluate the cost-effectiveness of treatments). UI total cost cover all the costs used, lost and include direct and indirect costs. Direct costs consist of costs related to diagnosis, treatment, routine care, and UI outcome costs while routine care costs make up a large portion of UI costs. Indirect costs are the invisible portion of the economic burden of UI, which is very difficult to calculate and is assumed to have a larger share than direct costs. In Turkey, there is no registration system or research yet concerning the UI and its economic burden, and available data is limited to the costs of diagnosis and treatment specified in the Healthcare Implementation Communiqué (SUT). In this review, the disease burden and cost of stress (SUI), urgency (UUI), and mixed urinary incontinence (MUI) have been investigated according to the literature and its current status was determined. Our study has revealed that UI creates a serious economic burden on the individual and the healthcare system, and that first-line healthcare services are key in reducing this burden. For the cost-effective management of UI in Turkey, it is important to determine the economic burden of the disease at the national level, to expose relevant direct and indirect costs, and to employ resources accurately and effectively.

Keywords:

urinary incontinence, disease burden, cost,

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D’Ancona C, Haylen B, Oelke M, Abranches‐Monteiro L, Arnold E, Goldman H, et al. The International Continence Society (ICS) report on the terminology for adult male lower urinary tract and pelvic floor symptoms and dysfunction. Neurourol Urodyn 2019; 38:433-477.
Milsom I, Gyhagen M. The prevalence of urinary incontinence. Climacteric 2019; 22:217-222.
ACOG (2015). Urinary incontinence in women. Practice Bulletin No. 155.https://journals.lww.com/greenjournal/Fulltext/2015/11000/Practice_Bulletin_No__155_Summary__Urinary.45.aspx
Çayan S, Yaman Ö, Orhan İ, Usta M, Başar M, Resim S, et al. Prevalence of sexual dysfunction and urinary incontinence and associated risk factors in Turkish women. Eur J Obstet Gynecol Reprod Biol 2016;203:303-308.
Sensoy N, Dogan N, Ozek B, Karaaslan L. Urinary incontinence in women: prevalence rates, risk factors and impact on quality of life. Pak J Med Sci 2013;29:818.
Akkus Y, Pinar G. Evaluation of the prevalence, type, severity, and risk factors of urinary incontinence and its impact on quality of life among women in Turkey. Int Urogynecol J 2016 ; 27:887-893.
Milsom I, Coyne KS, Nicholson S, Kvasz M, Chen CI, Wein AJ. Global prevalence and economic burden of urgency urinary incontinence: A systematic review. European Urol 2014;65:79-95.
Neubauer, G., Stiefelmeyer, S. Economic costs of urinary incontinence in Germany. In Urinary and Fecal Incontinence. Springer: Berlin, Heidelberg 2005. p. 25-31.
Levy R, Muller N. Urinary incontinence: Economic burden and new choices in pharmaceutical treatment. Adv Ther 2006;23:556-573.
Erbaydar NP. Hastalık yükü kavramı ve hesaplanmasında kullanılan ölçütler ve daly kavramına kısa bakış. Toplum Hekimliği Bülteni 2009;28:20-25.
Hu TW, Wagner TH, Hawthorne G, Moore K, Subak LL, Versi E. Economics of incontinence. Incontinence: 3rd International Consultation 2002;1:73-97.
Chong EC, Khan AA, Anger JT. The financial burden of stress urinary incontinence among women in the United States. Curr Urol Rep 2011;12:358-62.
Şahin Ş, Toprak S, Ünal E, Şahin Ş, Toprak S, Ünal E. QALY; Kaliteye ayarlı yaşam yılları. Medicine Science 2012;1:232-243.
Coyne KS, Wein A, Nicholson S, Kvasz M, Chen CI, Milsom I. Economic burden of urgency urinary incontinence in the United States: A systematic review. J Manag Care Spec Pharm 2014;20:130-140.
Kleinman NL, Chen CI, Atkinson A, Odell K, Zou KH. Economic burden of urge urinary incontinence in the workplace. J Occup Environ Med 2014;56:266-269. Continence Foundation of Australia. [Internet]. Can Australia afford incontinence? 2020 [cited 19 November 2020]. Available from: https://www.continence.org.au/news/can-australia-afford-incontinence
Wilson L, Brown JS, Shin GP, Luc KO, Subak LL. Annual direct cost of urinary incontinence. Obstet Gynecol 2001;98:398-406.
Papanicolaou S, Pons ME, Hampel C, Monz B, Quail D, Von der Schulenburg MG, et al. Medical resource utilisation and cost of care for women seeking treatment for urinary incontinence in an outpatient setting: Examples from three countries participating in the PURE study. Maturitas 2005;52:35-47.
Sağlık Uygulama Tebliği (Healthcare Implementation Communiqué ) [Internet]. SUT Tüm Ekleri. 2018 [cited 25 November 2019]. Avaible from: http://www.sutrehberi.com/sut-ekleri
Tediosi F, Parazzini F, Bortolotti A, Garattini L. The cost of urinary incontinence in Italian women. Pharmacoeconomics 2000;17:71-76.
Evaluation of uncomplicated stress urinary incontinence in women before surgical treatment. Committee Opinion No. 603. The American College of Obstetricians and Gynecologists. Obstet Gynecol 2014;123:1403–7.
Imamura M, Abrams P, Bain C, Buckley B, Cardozo L, Cody J, et al. Systematic review and economic modelling of the effectiveness and cost-effectiveness of non-surgical treatments for women with stress urinary incontinence. Health Technol Assess 2010;14:1-188.
Ward-Smith P. The cost of urinary incontinence. Int J Urol Nurs 2009;29:188-90.
Bostancı M, Özden S, Ünal O, Cevrioğlu AS, Akdemir N. Üriner inkontinans medikal tedavisi. Journal of Human Rhythm 2015;1:83-89.
Simpson AN, Garbens A, Dossa F, Coyte PC, Baxter NN, McDermott CD. A cost-utility analysis of nonsurgical treatments for stress urinary ıncontinence in women. Female Pelvıc Med Re 2019;25:49-55.
Laudano MA, Seklehner S, Chughtai B, Lee U, Tyagi R, Kavaler E, et al. Cost‐effectiveness analysis of tension‐free vaginal tape vs burch colposuspension for female stress urinary incontinence in the USA. BJU Int 2013;112:151-8.
Department of Health [Internet]. NHS reference costs 2006–07. London: Department of Health; Gateway Reference: 9280. 2008 [cited 12 December 2019]. Available from: uk/en/Publicationsandstatistics/Publications/PublicationsPolicyAndGuidance/DH_082571.
Lier D, Robert M, Tang S, & Ross S. Surgical treatment of stress urinary incontinence–trans‐obturator tape compared with tension‐free vaginal tape–5‐year follow up: an economic evaluation. BJOG 2016;124:1431-1439.
Cody J, Wyness L, Wallace S, Glazener C, Kilonzo M, Stearns S, et al. Systematic review of the clinical effectiveness and cost-effectiveness of tension-free vaginal tape for treatment of urinary stress incontinence. In NIHR Health Technology Assessment programme: Executive Summaries 2003. NIHR Journals Library. Rawlings T, Zimmern PE. Economic analyses of stress urinary incontinence surgical procedures in women. Neurourol Urodyn 2016;35:1040-1045.
Australian Institute of Health and Welfare (AIHW) [Internet]. Australian incontinence data analysis and development 2006 [cited from 12 December 2019]. Available from: http://www.aihw.gov.au/publications/dis/aidad/aidad_c00.pdf
Subak LL, Brown JS, Kraus SR, Brubaker L, Lin F, Richter HE, et al. The “costs” of urinary incontinence for women. Obstet Gynecol 2006;107:908.
Subak L, Van Den Eeden S, Thom D, et al. Urinary incontinence in women: direct costs of routine care. Am J Obset Gynecol 2007;197:596.
Langa KM, Fultz NH, Saint S, Kabeto MU, Herzog AR. Informal caregiving time and costs for urinary incontinence in older individuals in the United States. J Am Geriatr Soc 2002;50:733-737.
Albers‐Heitner CP, Joore MA, Winkens RAG, Lagro‐Janssen ALM, Severens JL, et al. Costeffectiveness of involving nurse specialists for adult patients with urinary incontinence in primary care compared to care‐as‐usual: An economic evaluation alongside a pragmatic randomized controlled trial. Neurourol Urodyn 2012;31:526-534.
Holtzer-Goor KM, Gultney JG, Van Houten P, Wagg AS, Huygens SA, Nielen MM. et al. Cost-effectiveness of including a nurse specialist in the treatment of urinary incontinence in primary care in the Netherlands. PloS One 2015;10(10):e0138225.
The Canadian Continence Foundation. [Internet]. The impact of incontinence in Canada a briefing document for policy-makers, Cameron Institute. 2014 [cited 13 December 2016]. Available from: http://www.cameroninstitute.org/2014/12/15/the-impact-of-incontinence-in-canada-a-briefing-document-for-policy-makers/
Continence Foundation of Australia. [Internet]. The economic impact of incontinence in Australia. Economics. 2011 [cited 13 December 2019]. Available from: https://www.continence.org.au/data/files/Access_economics_report/dae_incontinence_report__19_april_2011.pdf