OBJECTIVES Waking up at night to go to the bathroom interrupts sleep, with bothersome nocturia defined as two or more voids per night. Frequent bathroom visits at night can be caused in up to 80% of cases by the overproduction of urine, referred to as nocturia with nocturnal polyuria (Hofmeester et al. 2014), affecting about 20 percent of the overall population. This study assessed the associations between nocturia, workplace engagement and productivity and the corresponding economic burden for six countries.

METHODS Based on the largest international observational workplace survey on nocturia (93,000 adult participants aged >=18 years) we use multivariate regression models to assess the association between nocturia, workplace engagement (Utrecht Work Engagement Scale) and workplace productivity (WPAI-GH), separately by age and gender. To assess the macroeconomic cost of nocturia associated with lower workplace productivity and elevated mortality risk we apply a novel computational general equilibrium (CGE) model.

RESULTS : About 10 percent of the working-age population report two or more night-time voids. Individuals with nocturia report a 1.3 per cent lower engagement at work compared to individuals not suffering from the condition; and nocturia patients lose on average more than seven working days per year due to absenteeism and/or presenteeism, which is of the same magnitude of work impairment as observed among individuals with asthma or kidney disease.

Our economic estimations indicate that in terms of GDP losses due to nocturia-associated productivity, Australia loses annually about $3 billion, Spain $3.1 billion, the United Kingdom $6 billion, Germany $8.4 billion, Japan $13.7 billion, and the USA $44.4 billion.

CONCLUSIONS : This study provides evidence on the substantial economic burden associated with nocturia. With the economic implications of untreated nocturia, this should be a ‘wake-up’ call to patients, health-care providers, and employers of the importance of identifying and treating nocturia.