REVIEW – June 2008

Urinary incontinence and its cost


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Urinary incontinence (UI) is any involuntary leakage of urine. It is a common and distressing problem which may have a profound impact on quality of life. Functional incontinence may be caused by conditions not related to organic disorders of the bladder and urinary tract. The causes of functional incontinence include confusion, dementia, poor motility, and depression and anxiety disorders.

Stress incontinence is essentially due to the weakness of the pelvic floor muscles. Urge incontinence is most commonly caused by involuntary and inappropriate contractions of the detrusor muscles due to neurogenic causes or inflammation or irritation of the bladder. Overflow incontinence may result from obstruction of the lower urinary tract (prostatic hyperplasia, kidney stones) or autonomic neuropathy of the bladder. A combination of several causes of incontinence is referred to as mixed incontinence.

Treatment options in the case of incontinence include physical exercise, medical therapy and surgical intervention.

The cost of care per day for patients with UI in a nursing hospital was analysed. The total cost per patient per day in 2004 was 56 EEK. The direct cost of adult diapers was 34%,the labour cost was 34% and the lavatory cost was 18%. Using better quality incontinence pads may diminish the labour covering lavatory expenses. In hospitals, care providers should spend additional 62.4 minutes per day per incontinent patient. The time can vary from 40 to 80 additional minutes of labour.. In 2005 the estimated cost of diapers per patient per year was 5478 EEK (350 EUR).

The cost model can also be used as a sales tool for diaper manufacturers, as well as for institutions (like hospitals and nursing homes) that are not yet prepared to calculate and plan the cost of incontinence care. There is no unified (standardised) method to calculate existing costs.

In hospitals, the total cost of incontinence is calculated for each specialised unit. For example, in the surgical unit, average diaper use per incontinent patient per day is 0.78 while in the nursing unit the corresponding figure is 2.3. In case both departments serve the same number of patients, the cost of diapers will be 34% lower for the surgical unit.

In a nursing home the total cost of incontinence depends on the condition of patients: :for example, the need of mobile patients with mild or severe incontinence for medical resources is lower compared to that of reclined patients with severe incontinence.