The direct medical cost of urinary and fecal incontinence by care settings for adults over 65 in the United States

Abstract Background Incontinence is a chronic condition that affects millions of adults over the age of 65 in the United States. This study estimates the direct medical costs of incontinence for this population and identifies some possible root causes driving these costs. Methods This retrospective analysis relied on administrative claims data from the 2018 Medicare Limited Data Set. The cost analysis was limited to fee-for-service (FFS) Medicare beneficiaries over the age of 65 enrolled in Medicare Parts A and B. Our analysis of urinary tract infections (UTIs) relied on a Medicare Advantage dataset from 2016 to 2018 that included service and drug costs. We used diagnosis codes and place-of-service codes from the 2018 claims experience to identify incontinent members and their respective care setting. We used propensity score matching of incontinent and non-incontinent members to estimate the incremental cost of incontinence, controlling for age, gender, regional state groupings, and 79 comorbidities based on ICD-10CM codes, categorized into 9 disease groups. We also created an event study of UTIs to explore whether the cost of a UTI episode differs based on the presence of incontinence. Results On average, direct medical costs for incontinent members were $404 per member per month (PMPM) in 2018 USD higher than their non-incontinent counterparts in the same care setting. This gap rises to $968 PMPM when averaged over all members across all four care settings because it accounts for the disproportionate migration of incontinent members into more intensive and expensive care settings. A significant driver of these costs is the higher prevalence of urinary tract infections (UTIs) among incontinent members. Using an event study of UTIs, we also find that the treatment costs for UTIs are 52% higher, on average, for incontinent members. Conclusion The direct medical cost of incontinence for adults over 65 is comparable in magnitude to other major chronic conditions such as obesity, cancer, and diabetes, yet receives far less policy and management attention. Payers and institutions can make meaningful gains in reducing this cost by investing in incontinence management strategies that reduce UTIs, support caregivers, and prevent transitions to higher-intensity care settings.