Economic costs of urinary incontinence
Economic costs of urinary incontinence
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尿失禁的经济成本
DOI：
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发表时间：
2005
影响因子：
1.8
通讯作者：
T. Hu
中科院分区：
文献类型：
--
作者：
T. H. Wagner;T. Hu
尿失禁（UI）给患者和整个社会带来了不可否认的经济负担。1995年，UI的经济成本总计263亿美元，或每个65岁及以上的患者3，565美元[1]。无论是卫生从业者还是决策者，这都是一个惊人的数字。为了理解如何计算这个总数，首先重要的是要理解，无论患者是否接受治疗，都有与UI相关的成本。如果一个人害怕就医，那么诊断和治疗费用将为零。然而，当UI得不到治疗时，就会产生费用。这些成本包括日常护理成本（如一次性内裤和洗衣），后果成本，如治疗尿路感染和入住养老院，间接成本（即生产力损失）和无形成本（即疼痛，压力和痛苦）。同样，如果患者接受治疗并变得有节制，则会产生治疗费用，但减轻了常规、后果、间接和无形费用。请注意，如果我们想进行成本效益分析，我们会将治疗成本与减少常规护理成本、后果成本、间接成本和无形成本所节省的金钱进行比较。我们指出这一点是因为医学文献中的大多数经济学研究要么是成本效益研究，要么是成本效益研究。相比之下，我们的研究仅测量了1995年UI造成的总经济负担。在263亿美元中，48%（125亿美元）的资源直接来自经济，用于诊断，治疗，护理和康复UI患者。这些资源可进一步分为诊断、治疗和常规护理费用。总之，在过去15年中，这些费用得到了比较充分的研究，从1984年的39.4亿美元[2]增加到1993年的101.2亿美元[3]，再增加到1995年的125.3亿美元，部分原因是医疗保健和日常护理费用的增加，部分原因是老年人人口的增加。与UI后果相关的成本更难量化。虽然医学界意识到UI可能导致尿路感染，皮肤刺激和入住疗养院，但很难确定这些费用中有多少部分应归因于失禁本身。1995年，这些费用估计为131亿美元，但这应被视为近似值，而不是实际数字。诊断、治疗、常规护理和后果费用总计256亿美元。其余7.04亿美元为间接费用，即收入损失的价值。总成本中不包括疼痛、压力和痛苦的货币价值。因此，尽管这个总成本很大，但它是保守的。从某种意义上说，我们的成本研究就像一本长书的序言，其余的部分有待撰写。如果有人要研究UI的经济学，我们可以设想以下章节：
Urinary incontinence (UI) imposes an undeniable financial burden upon those with the condition, and on society as a whole. In 1995 the economic costs of UI totaled $26.3 billion, or $3,565 per individual aged 65 and older with the condition [1]. Whether one is a health practitioner or a policy maker, this is a staggering amount. To understand how this total was calculated, first it is important to understand that there are costs associated with UI whether the person is treated or not. If a person is afraid to seek medical attention, then diagnostic and treatment costs will be zero. However, costs are incurred when UI goes untreated. These include routine care costs (e.g. disposable briefs and laundry), consequence costs, such as treating urinary tract infections and admissions to a nursing home, indirect costs (i.e. lost productivity), and intangible costs (i.e. pain, stress and suffering). Likewise, if the person is treated and becomes continent, treatment costs are incurred but the routine, consequence, indirect and intangible costs are mitigated. Note that if we wanted to conduct a cost-benefit analysis we would compare the treatment costs to monetary savings from reduced routine care costs, consequence costs, indirect costs and intangible costs. We point this out because most of the economic studies in the medical literature are either cost-benefit or costeffectiveness studies. In contrast, our study only measured the total economic burden imposed by UI in 1995. Of the $26.3 billion, 48% ($12.5 billion) of these resources were drawn directly from the economy to diagnose, treat, care for and rehabilitate patients with UI. These resources can be further categorized into diagnostic, treatment and routine care costs. In sum, these costs have been relatively well studied over the past 15 years, and they have increased from $3.94 billion in 1984 [2], to $10.12 billion in 1993 [3], to $12.53 billion in 1995, owing partly to increases in the cost of medical care and routine care, and partly to a growing population of older adults. The costs associated with consequences of UI are harder to quantify. Whereas the medical community is aware that UI can lead to urinary tract infections, skin irritation and admission to a nursing home, it is harder to identify what fraction of these costs should be attributed to the incontinence itself. In 1995 these costs were estimated at $13.1 billion, but this should be viewed as an approximation rather than an actual figure. Together, the diagnostic, treatment, routine care and consequence costs totaled $25.6 billion. The remaining $704 million are indirect costs, which are the value of lost earnings. Not included in the total cost is the monetary value of pain, stress, and suffering. Hence, even though this total cost is large, it is conservative. In some sense our cost study is like a prologue in a long book, the rest of which is waiting to be written. If o n e were going to study the economics of UI, we could envisage chapters covering the following: