Top 10 diseases by cost

Bladder, prostate and other urinary tract diseases cost Americans nearly $11 billion a year, according to a new report from the National Institutes of Health.

Medicare's share exceeded $5.4 billion.

The five most expensive urologic problems--accounting for $9.1 billion--are, in descending order, urinary tract infections, kidney stones, prostate and bladder cancers and benign prostate enlargement, according to the authors of Urologic Diseases in America. The report was published online this spring and will be available in print and on CD in early May.

"This research sharply illustrates the immense burden of urologic diseases and the importance of studies to preempt disease processes and develop targeted treatments," said Elias A. Zerhouni, M.D., NIH Director.

Five years in the making, Urologic Diseases in America stitches together a patchwork of reliable data, both new and previously published, revealing numbers of people affected, treatment patterns and economic cost.

TOP 10 DISEASES BY COST
Total

Infection (Women & Men)
$3.5 Billion

Kidney Stones
$2.1 Billion

Prostate Cancer
$1.3 Billion

Bladder Cancer
$1.1 Billion

BPH/Prostate Enlargement
$1.1 Billion

Urinary Incontinence
$463.1 Million

Kidney Cancer
$401.4 Million

Erectile Dysfunction
$327.6 Million

Prostatitis
$84.4 Million

Interstitial Cystitis/PBS
$65.9 Million

"The data have broad implications for quality of care and access to care and helps to inform discussions about health care and research needs," said UDA coeditor Mark S. Litwin, M.D., M.P.H, a urologist at the David Geffen School of Medicine and School of Public Health at the University of California, Los Angeles.

Urologic Diseases in America describes more than a dozen diseases of children and adults, among them congenital abnormalities, erectile dysfunction, chronic prostatitis, interstitial cystitis, urinary incontinence and a chapter on sexually transmitted diseases, contributed by the Centers for Disease Control and Prevention. Findings include:

• Medical care for nearly 12.8 million urinary tract infections in women alone costs nearly $2.5 billion annually. Adding the cost for men raises the total to $3.5 billion; Medicare's share was $1.4 billion. Another $96.4 million was spent on 3.3 million prescriptions. More than half of all women will have an infection during their lifetimes. Reporting a trend toward using newer, and more expensive, fluoroquinolones raises concerns about increasing antibiotic resistance said UDA authors. And while only 20 percent of infections are in men, they are more often hospitalized and out of work about twice as long as women.
• While hospitalizations, length of stay and the need for open surgery are declining for kidney stones, medical care still costs $2.1 billion annually, with another $4 million to $14 million spent on prescription drugs. Men are two to three times more likely than women to develop a stone, but more people of all ages and races are getting them: an estimated 5 percent of adults between 1988 and 1994, up from nearly 4 percent between 1976 and 1980. Compared to whites, African Americans and Mexican Americans have a 70 percent and 35 percent lower risk, respectively, of developing a stone.
• Although data for childhood urologic diseases are scarce, urinary problems in children cost at least $75 million dollars a year. Vesicoureteral reflux, the abnormal flow of urine from the bladder up toward the kidneys, affects about 10 percent of all children and makes them prone to urinary tract infections and kidney damage. The cost of hospitalizations for reflux alone rose from $10 million in 1997 to $47 million in 2000; Southern states, defined using U.S. Census Bureau regions, saw the highest rise--56 percent--attributable to a doubling in the number of cases.

"Our biggest challenge was finding reliable data in children," said Christopher Saigal, M.D., M.P.H., Litwin's coeditor at UCLA and RAND Health. "More research is needed in children."

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