OBJECTIVES : To evaluate guideline adherence, healthcare resource use (HRU) and costs in women with stress or mixed urinary incontinence (SUI/MUI) compared to a matched cohort of women without UI.

METHODS : Female patients with claims including a diagnosis of SUI or MUI (ICD-9-CM: 625.6, 788.33 or ICD-10-CM: N39.3, N39.46) between 07/01/2014-06/30/2016 were matched on age, gender and Charlson’s Comorbidity Index in IBM’s MarketScan Research Database to a cohort without any UI-related diagnoses. First SUI/MUI diagnosis claim determined index date in cases and was assigned to each matched control. Inclusion criteria included absence of pregnancy claims and ≥80% medical and pharmacy enrollment pre- and post-index. HRU and payer costs were compared between SUI/MUI cases and controls during the two years post-index using paired t-tests. Costs associated with SUI/MUI guideline adherence (non-pharmacologic treatment before pharmacologic treatment or surgery) were evaluated post-index (two years) in the SUI/MUI cohort.

RESULTS : 68,636 SUI/MUI patients and 68,636 matched controls were identified. SUI/MUI patients had significantly higher average outpatient, inpatient, primary care and specialist visits (7.79 vs. 4.83), (0.28 vs. 0.18), (7.33 vs. 5.53), and (1.2 vs. 0.08), respectively compared to control subjects (all significant at p<0.0001). SUI/MUI patients had significantly higher two-year average prescription anticholinergic medication claims compared to controls (6.09 vs. 4.16; p<0.0001) and two-year mean medical costs were significantly higher in SUI/MUI patients compared to controls ($27,446.50 vs. $17,035; p<0.0001). Guideline adherence by utilizing recommended first-line therapies (pelvic floor exercises, physical therapy, and behavioral modification) before adding medication or surgery was observed in only 4% of SUI/MUI patients and was associated with lower average two-year medical costs: $1,443 (non-pharmacologic treatment first) vs. $1,653 (pharmacologic treatment first) vs. $5,765 (surgery first)].

CONCLUSIONS : The diagnosis of SUI/MUI is associated with significantly higher HRU and cost burden to payers. Improved guideline adherence using non-pharmacologic treatments first-line may reduce costs in this population.