Kristin Khalaf

Impact of urinary incontinence on healthcare resource utilization, health-related quality of life and productivity in patients with overactive bladder

To evaluate the impact of urinary incontinence (UI) on healthcare resource utilization (HRU), health‐related quality of life (HRQoL) and productivity measures in patients with overactive bladder (OAB).

Health-related quality of life and economic impact of urinary incontinence due to detrusor overactivity associated with a neurologic condition: a systematic review

BackgroundPatients with neurologic diseases often have neurogenic detrusor overactivity (NDO), which can result in a loss of voluntary bladder control and uncontrollable urinary incontinence (UI).The impact of UI due to NDO on patients’ lives has not been well studied. The objective of this review was to assess the health-related quality of life (HRQoL) and economic burden in patients with urgency UI due to NDO in select countries in North America, the European Union, Asia, and Australia.MethodsSystematic literature searches and reviews of articles published in English (January 2000 to February 2011) were conducted using MEDLINE®, EMBASE®, and the Cochrane Library. Studies assessing the impact of UI on HRQoL of patients with an underlying neurologic condition of interest (i.e., multiple sclerosis, spinal cord injury, Parkinson’s disease, stroke, or spina bifida) were included. Economic studies in urgency UI also were included.ResultsOf 876 citations generated in the initial search, a total of 27 articles were deemed relevant: 16 articles presented HRQoL data and 11 articles presented information on the economic burden of UI. Humanistic studies used a range of HRQoL instruments to measure HRQoL burden, and the economic studies included different cost components to quantify the economic burden, making meaningful comparisons challenging. Despite this heterogeneity, the literature suggests that HRQoL in patients with UI due to NDO is worse than patients with UI in general or those with the same underlying neurologic condition without UI. In addition, urgency UI also results in substantial economic costs.ConclusionsIncontinent patients with underlying neurologic conditions have impaired HRQoL as well as substantial economic burden attributable to UI due to NDO. There is a need for urgency UI treatments that improve HRQoL of these patients and alleviate the economic burden of this condition.

Mapping EQ-5D Utility Scores from the Incontinence Quality of Life Questionnaire among Patients with Neurogenic and Idiopathic Overactive Bladder

OBJECTIVES To provide a mapping algorithm for estimating EuroQol five-dimensional (EQ-5D) questionnaire index scores from the Incontinence-specific Quality of Life questionnaire (I-QOL) based on nationally representative samples of patients with idiopathic or neurogenic overactive bladder (OAB) using EQ-5D questionnaire preference valuations based on both the UK and US general populations. METHODS Analyses were conducted for 2505 patients from the Adelphi Overactive Bladder Disease Specific Programme, a cross-sectional study of patients with idiopathic or neurogenic OAB, undertaken in the United States and Europe in 2010. A range of statistical modeling techniques was used. Tenfold cross-validation techniques were used to calculate mean absolute error (MAE) and root mean squared error (RMSE) goodness-of-fit statistics. Various predictor lists, together with a method combining stepwise selection with multivariable fractional polynomial techniques to allow nonlinear relationships to feature, were pursued. RESULTS Choice of predictors was consistent for both the UK and US EQ-5D questionnaire tariffs. For idiopathic, the best model included the I-QOL total score and age (both modeled nonlinearly.) For neurogenic, the best model was the I-QOL social embarrassment domain score modeled linearly only. Best-fit results were better in the idiopathic (n = 2351; MAE = 0.10; RMSE = 0.14) than in the neurogenic sample (n = 254; MAE = 0.17; RMSE = 0.22). CONCLUSIONS This research provides algorithms for mapping EQ-5D questionnaire index scores from the I-QOL, allowing calculation of appropriate preference-based health-related quality-of-life scores for use in cost-effectiveness analyses when only I-QOL data are available. The strongest results were for idiopathic patients, but those for neurogenic are consistent with those of other published mapping studies.

Lower Urinary Tract Symptom Prevalence and Management Among Patients with Multiple Sclerosis

BACKGROUND This study was conducted to assess self-reported prevalence and management of lower urinary tract symptoms (LUTS), along with drivers of treatment seeking, among patients with multiple sclerosis (MS). METHODS An online, cross-sectional survey was administered to US-residing participants with self-reported MS to assess presence of LUTS, including urinary incontinence (UI). Participants experiencing LUTS were asked additional questions related to management and current therapies. Multivariate logistic regression identified drivers of treatment-seeking behavior. RESULTS A total of 1052 participants completed the survey; 1047 were included in the analysis. Nine hundred sixty-six participants (92%) reported at least one LUTS, the most common being post-micturition dribble (64.9%), urinary urgency (61.7%), and a feeling of incomplete emptying (60.7%). Eight hundred twenty-six (79%) reported having some type of UI. Of those with any type of LUTS, 70% (n = 680) had previously discussed urinary symptoms with a health-care provider (HCP), while only 32% (n = 311) had seen an HCP in the past year. Logistic regression found urgency (odds ratio [OR] 1.20 [95% confidence interval (CI), 1.00-1.44]), intermittent urine stream (OR 1.40 [95% CI, 1.15-1.69]), and urgency UI (OR 1.78 [95% CI, 1.22-2.60]) to be significant predictors of seeking treatment. Of those who had discussed LUTS with an HCP, 480 (70.6%) were currently receiving at least one LUTS treatment; the most common treatments were reducing fluid intake, pelvic exercises, oral anticholinergic medications, and avoiding certain foods/alcohol. CONCLUSIONS LUTS are commonly experienced among people with MS but are largely untreated. Proper LUTS assessment and work-up is warranted in MS patients.

The impact of lower urinary tract symptoms on health-related quality of life among patients with multiple sclerosis.

Lower urinary tract symptoms are commonly experienced among patients with multiple sclerosis (MS), however, their impact on health‐related quality of life (HRQOL) has not been well characterized. Herein the incremental impact of lower urinary tract symptoms on HRQOL among patients with MS has been evaluated.

Comparative assessment of onabotulinumtoxinA and mirabegron for overactive bladder: an indirect treatment comparison

Context OnabotulinumtoxinA and mirabegron have recently gained marketing authorisation to treat symptoms of overactive bladder (OAB). Objective To evaluate the relative efficacy of mirabegron and onabotulinumtoxinA in patients with idiopathic OAB. Design Network meta-analysis. Data sources A search of 9 electronic databases, review documents, guidelines and websites. Methods Randomised trials comparing any licensed dose of onabotulinumtoxinA or mirabegron with each other, anticholinergic drugs or placebo were eligible (19 randomised trials were identified). 1 reviewer extracted data from the studies and a second reviewer checked the data. Candidate trials were assessed for similarity and networks were developed for each outcome. Bayesian network meta-analysis was conducted using both fixed-effects and random-effects models. When there were differences in mean baseline values between mirabegron and onabotulinumtoxinA trials they were adjusted for using network meta-regression (NMR). Results No studies directly comparing onabotulinumtoxinA to mirabegron were identified. A network was created for each of the 7 outcomes, with 3–9 studies included in each individual network. The trials included in the networks were broadly similar. Patients in the onabotulinumtoxinA trials had more urinary incontinence and urgency episodes at baseline than patients in the mirabegron trials and these differences were adjusted for using NMR. Both onabotulinumtoxinA and mirabegron were more efficacious than placebo at reducing the frequency of urinary incontinence, urgency, urination and nocturia. OnabotulinumtoxinA was more efficacious than mirabegron (50 and 25 mg) in completely resolving daily episodes of urinary incontinence and urgency and in reducing the frequency of urinary incontinence, urgency and urination. NMR supported the results of the network meta-analysis. Conclusions In the absence of head-to-head trials comparing onabotulinumtoxinA to mirabegron, this indirect comparison indicates that onabotulinumtoxinA may be superior to mirabegron in improving symptoms of urinary incontinence, urgency and urinary frequency in patients with idiopathic OAB.

Patient‐reported goal achievement following onabotulinumtoxinA treatment in patients with neurogenic detrusor overactivity

To identify the self‐reported treatment goals of patients with urinary incontinence (UI) due to neurogenic detrusor overactivity (NDO), determine whether patients achieved their goals following onabotulinumtoxinA treatment, and assess impact of neurogenic disease (multiple sclerosis or spinal cord injury) and/or clean intermittent catheterization (CIC) on goal achievement.

108 PREVALENCE OF LOWER URINARY TRACT SYMPTOMS AMONG PATIENTS WITH MULTIPLE SCLEROSIS

INTRODUCTION AND OBJECTIVES: Although the presence of bladder dysfunction in patients with multiple sclerosis (MS) has been well established, the prevalence of specific lower urinary tract symptoms (LUTS)in this population is not well-documented. The purpose of this study was to assess the self-reported prevalence of all LUTS according to International Continence Society (ICS) definitions in MS patients. METHODS: An online cross-sectional survey was administered to a convenience sample of US-residing participants with MS who were recruited through web-based patient advocacy organizations. Participants responded to questions pertaining to demographics, disease history, productivity, urinary symptoms, and health-related quality of life. LUTS were assessed using the LUTS Tool, a validated questionnaire that assesses the presence of these symptoms. RESULTS: A total of 1052 MS participants completed the survey. Eighty one percent were women and the mean age 48 years (SD 10.6). The mean duration of MS was 8.5 years (SD 7.8). The most commonly reported LUTS was post-micturition dribble (64.9%), followed by urinary urgency (61.7%) and incomplete emptying (60.7%). The most common type of urinary incontinence (UI) reported was urgency incontinence (UUI) (52.6%), followed by stress incontinence (45.3%). Of the 551 participants with UUI, the majority (79%) had mixed UI. Univariate logistic regression showed that compared to participants with normal or mild disability, participants with moderate disability or some gait disability were 2.4 times more likely to report UUI (p 0.01), while those requiring the assistance of a cane were 5.1 times more likely to report UUI (p 0.01). Participants reporting the need for bilateral assistance or a wheelchair or scooter to traverse 25 feet were 4.9 times more likely to report UUI (p 0.01). There was no increased likelihood of having stress incontinence across increasing levels of self-reported disability status. CONCLUSIONS: The majority (88%) of participants with MS reported having a variety of LUTS. Participants with greater disability due to their MS are more likely have symptoms of urgency and UUI.