As the elderly population in the United States continues to grow rapidly, it’s expected that the prevalence of fecal incontinence will also increase substantially. The condition is highly prevalent in both older men and women.
Fecal incontinence can significantly decrease quality of life because patients often find it difficult to hide odor issues. In many cases, they develop depression and become socially isolated. Many sufferers live with the condition for 5 years or longer before seeking treatment. Despite its prevalence and harmful impact on patients and their caregivers, fecal incontinence remains understudied in clinical research. Furthermore, few studies have looked at its economic burden in the U.S.
Quantifying Costs of Fecal Incontinence
In Diseases of the Colon & Rectum, my colleagues and I had a study published that aimed to quantify per-patient annual costs associated with fecal incontinence. Patients with the condition were mailed a survey in 2010 to collect information on their sociodemographic characteristics, symptoms, and use of medical and non-medical resources for fecal incontinence. The analysis included 332 adult patients who had fecal incontinence for more than a year with at least monthly leakage of solid, liquid, or mucous stool.
Three categories of cost were examined in the study: 1) direct medical costs, including dollars spent for diagnosis, treatment, and management of the condition; 2) direct non-medical costs, including dollars spent for non-medical resources, such as protective products or transportation to care; and 3) indirect costs, such as accountable dollars from loss of productivity. Unit costs were determined based on standard Medicare reimbursement rates, national average wholesale prices of medications, and estimates from other relevant sources.
According to our results, the average annual total cost for fecal incontinence was $4,110 per person. Of these costs, direct medical costs averaged $2,353, whereas direct non-medical costs averaged $209 per year. Indirect costs resulting from productivity loss were also significant, averaging $1,549 per patient annually. In multivariate regression analyses, we found that people who had more severe symptoms of fecal incontinence experienced higher direct costs each year.
Attention Needed in Patient Discussions
It’s critical that fecal incontinence is not forgotten in discussions about healthcare dollars. More research from across the country is needed. Importantly, it appears that the annual cost of fecal incontinence is similar to that of urinary incontinence, but urinary incontinence is talked about more freely by patients and their healthcare providers than fecal incontinence.
“It’s critical that fecal incontinence is not forgotten in discussions about healthcare dollars.”
Physicians can help alleviate the economic burden of fecal incontinence by talking openly with their patients and offering preventive treatments. For many patients, earlier treatment can improve quality of life significantly. Several treatment options are available, including diet management, physical therapy for pelvic floor issues, and anti-diarrheal medications. In addition, more and more surgical options are emerging. It’s possible that these interventions could also generate financial benefits, especially among those with more severe fecal incontinence.
Xu X, Menees SB, Zochowski MK, Fenner DE. Economic cost of fecal incontinence. Dis Colon Rectum. 2012;55:586-598. Available at: http://journals.lww.com/dcrjournal/Abstract/2012/05000/Economic_Cost_of_Fecal_Incontinence.13.aspx.
Sung VW, Washington B, Raker CA. Costs of ambulatory care related to female pelvic floor disorders in the United States. Am J Obstet Gynecol. 2010;202:483.e1-e4.
Dunivan GC, Heymen S, Palsson OS, et al. Fecal incontinence in primary care: prevalence, diagnosis, and health care utilization. Am J Obstet Gynecol. 2010;202:493.e1-e6.
Sung VW, Rogers ML, Myers DL, Akbari HM, Clark MA. National trends and costs of surgical treatment for female fecal incontinence. Am J Obstet Gynecol. 2007;197:652.e1-e5.
Farage MA, Miller KW, Berardesca E, Maibach HI. Psychosocial and societal burden of incontinence in the aged population: a review. Arch Gynecol Obstet. 2008;277:285-290.