Burden of illness among intermittent catheter users with non-neurogenic urinary retention in Denmark

Figures & data

Figure 1. Flowchart of study population.

BPH: benign prostatic hyperplasia, UR: urinary retention, SCI: spinal cord injury, MS: multiple sclerosis, SB: spina bifida, IC: intermittent catheterisation, CRS: Civil registration system.

Table 1. Demographic characteristics of case and matched control groups at index.

	BPH		Other non-neurogenic causes
	Case	Control	Case	Control
Subjects, n	4,758	18,253	3,618	13,941
Patient-years, n	3,795	17,951	3,513	13,740
Age, mean ± sd	70.4 ± 9.0	70.1 ± 9.0	64.7 ± 15.5	64.3 ± 15.5
Gender, %
Male	100.0	100.0	65.9	65.4
Female	-	-	34.1	34.6
Age groups (years), %
18–20	0.4	0.4	0.6	0.6
21–30			3.6	3.7
31–40			5.6	5.8
41–50	1.7	1.7	7.7	7.9
51–60	10.8	11.1	13.1	13.4
61–70	37.3	38.2	27.4	27.5
71–80	36.8	36.5	29.7	29.6
>80	13.1	12.1	12.3	11.5
Marital status, %
Living alone	23.6	22.7	32.8	32.1
Married/cohabitation	76.4	77.3	67.2	67.9
Education, %
Primary	29.8	30.3	33.9	34.5
Secondary	1.5	1.3	3.3	3.0
Vocational	41.2	42.1	39.1	40.0
Short college	3.7	3.4	3.4	3.0
Bachelor	12.9	12.8	12.2	12.1
Master/PhD	7.8	7.3	5.4	5.1
Unknown	3.2	2.9	2.7	2.2
Danish region, %
Northern region	11.3	11.2	11.2	11.2
Central region	30.5	30.8	30.2	30.2
Southern region	26.3	26.4	25.7	25.8
Capital region	20.0	19.9	18.7	18.7
Region Zealand	12.0	11.7	14.2	14.2
Dead in post-period, %	3.0	3.3	6.3*	2.8

BPH: benign prostatic hyperplasia; SD: standard deviation; *Significantly different from matched control group (p < 0.000).

Figure 2. Predicted total mean healthcare costs in EUR per patient-year for case and matched control groups. All differences between case and matched control group were significant (p < 0.000). Please refer to Table S9 for confidence intervals.

A 2-step one-model GLM regression model was used to predict costs. BPH: benign prostatic hyperplasia.

Table 2. Predicted total mean health-care utilization per patient-year for case and matched control groups.

Total health-care utilization, mean [95% CI]
	Case group	Control group
	BPH
Hospital admissions	1.4 [1.3; 1.5]*	0.3 [0.3; 0.4]
Days in hospital	5.8 [5.7; 6.0]*	1.9 [1.9; 2.0]
Outpatient visits	13.2 [13.0; 13.5]*	3.6 [3.6; 3.6]
30-day re-admission	0.4 [0.3; 0.4]*	0.1 [0.1; 0.1]
Primary health-sector services	51.9 [51.5; 52.4]*	25.9 [25.8; 26.0]
	Other non-neurogenic causes
Hospital admissions	1.2 [1.2; 1.3]*	0.3 [0.3; 0.3]
Days in hospital	6.4 [6.2; 6.6]*	1.6 [1.6; 1.6]
Outpatient visits	14.0 [13.7; 14.3]*	3.6 [3.5; 3.6]
30-day re-admission	0.4 [0.4; 0.5]*	0.1 [0.1; 0.1]
Primary health-sector services	47.0 [46.5; 47.4]*	26.0 [25.9; 26.1]

A Poisson model was used to predict utilization. BPH: benign prostatic hyperplasia; CI: confidence interval; *Significantly different from matched control group (p < 0.000).

Table 3. Predicted mean utilization and costs in EUR per patient-year of selected primary health-sector services for case and matched control groups.

Utilization of selected health-sector services, mean [95% CI]
	Case group	Control group
	BPH
General practitioner	38.2 [37.8; 38.6]*	15.7 [15.6; 15.7]
On-call doctor	1.1 [1.0; 1.2]*	0.3 [0.3; 0.3]
	Other non-neurogenic causes
General practitioner	33.9 [33.5; 34.2]*	15.6 [15.5; 15.6]
On-call doctor	1.3 [1.2; 1.4]*	0.4 [0.4; 0.4]
Costs of selected health-sector services, mean [95% CI]
	Case group	Control group
	BPH
General practitioner	431 [410; 453]*	201 [198; 204]
On-call doctor	24 [23; 26]*	7 [7; 7]
	Other non-neurogenic causes
General practitioner	381 [361; 402]*	195 [192; 198]
On-call doctor	26 [25; 28]*	8 [8; 8]

A Poisson model was used to predict utilization, and a two-step one-model GLM regression model was used to predict costs. BPH: benign prostatic hyperplasia; CI: confidence interval; *Significantly different from matched control group (p < 0.000).

Figure 3. Predicted mean costs in EUR per patient-year of selected prescription drugs for case and matched control groups. All differences between case and their matched control groups are significant (p < 0.000). Please refer to Table S10 for confidence intervals.

A 2-step one-model GLM regression model was used to predict costs. BPH: benign prostatic hyperplasia; UTI: urinary tract infection; *Antibacterial for systemic use is medication without UTI indication.

Table 4. Predicted inpatient and outpatient mean utilization per patient-year of bladder complications for case and matched control groups.

	Hospital admissions, mean [95% CI]		Days in hospital, mean [95% CI]		Outpatient visits, mean [95% CI]
	Case group	Control group	Case group	Control group	Case group	Control group
	BPH
UTI cluster	0.10 [0.07;0.15]*	0.01 [0.00; 0.01]	0.48 [0.41; 0.56]*	0.04 [0.04; 0.04]	0.16 [0.11; 0.23]*	0.01 [0.01; 0.01]
Urosepsis	0.03 [0.01; 0.07]*	0.00 [0.00; 0.00]	0.17 [0.12; 0.23]*	0.01 [0.01; 0.01]	0.02 [0.01; 0.04]*	0.00 [0.00; 0.00]
Upper UTI	0.01 [0.00; 0.05]*	0.00 [0.00; 0.00]	0.04 [0.02; 0.07]*	0.00 [0.00; 0.00]	0.00 [0.00; 0.01]**	0.00 [0.00; 0.00]
Lower UTI	0.04 [0.02; 0.07]*	0.00 [0.00; 0.00]	0.15 [0.11; 0.19]*	0.02 [0.01; 0.02]	0.13 [0.08; 0.20] *	0.00 [0.00; 0.00]
UTI, site unspecified	0.03 [0.01; 0.06]*	0.00 [0.00; 0.00]	0.12 [0.09; 0.17]*	0.01 [0.01; 0.01]	0.01 [0.01; 0.04]*	0.00 [0.00; 0.00]
Kidney disease	0.03 [0.02; 0.04]*	0.00 [0.00; 0.01]	0.15 [0.12; 0.18]*	0.03 [0.03; 0.03]	0.90 [0.83; 0.97]*	0.19 [0.19; 0.20]
Stones in urinary tract or kidney	0.01 [0.01; 0.02]*	0.00 [0.00;0.00]	0.02 [0.01; 0.04]*	0.00 [0.00; 0.01]	0.06 [0.04; 0.08]*	0.01 [0.01; 0.02]
Urethral stricture/urinary tract obstruction/hematuria	0.07 [0.04; 0.12]*	0.00 [0.00; 0.00]	0.23 [0.17; 0.31]*	0.01 [0.01; 0.01]	0.19 [0.15; 0.25]*	0.01 [0.01; 0.01]
Cancer in bladder or urethra	0.02 [0.01; 0.03]*	0.00 [0.00; 0.00]	0.07 [0.05; 0.09]*	0.02 [0.01; 0.02]	0.10 [0.08; 0.14]*	0.02 [0.01; 0.02]
Dehydration	0.01 [0.00; 0.01]	0.00 [0.00; 0.01]	0.04 [0.03; 0.05]**	0.03 [0.03; 0.03]	0.01 [0.00; 0.02]*	0.00 [0.00; 0.00]
Sepsis	0.02 [0.01; 0.03]*	0.00 [0.00; 0.00]	0.13 [0.10; 0.16]*	0.02 [0.02; 0.02]	0.01 [0.00; 0.03]*	0.00 [0.00; 0.00]
	Other non-neurogenic causes
UTI cluster	0.10 [0.06; 0.16]*	0.01 [0.00; 0.01]	0.47 [0.39; 0.57]*	0.03 [0.03; 0.04]	0.28 [0.19; 0.41]*	0.01 [0.01; 0.01]
Urosepsis	0.02 [0.01; 0.06]*	0.00 [0.00; 0.00]	0.13 [0.08; 0,20]*	0.01 [0.01; 0.01]	-	-
Upper UTI	0.01 [0.00; 0.03]*	0.00 [0.00; 0.00]	0.04 [0.02; 0.08]*	0.00 [0.00; 0.00]	0.04 [0.01; 0.13]*	0.00 [0.00; 0.00]
Lower UTI	0.04 [0.02; 0.09]*	0.00 [0.00; 0.00]	0.14 [0.10; 0;20]*	0.01 [0.01; 0.01]	0.21 [0.14; 0.32]*	0.01 [0.01; 0.01]
UTI, site unspecified	0.03 [0.01; 0.07]*	0.00 [0.00; 0.00]	0.16 [0.12; 0.21]*	0.01 [0.01;0.02]	0.01 [0.00; 0.06]*	0.00 [0.00; 0.00]
Kidney disease	0.02 [0.01; 0.04]*	0.00 [0.00; 0.00]	0.11 [0.08; 0.15]*	0.01 [0.01; 0.02]	0.70 [0.63; 0.77]*	0.18 [0.17; 0.18]
Stones in urinary tract or kidney	0.01 [0.00; 0.02]*	0.00 [0.00; 0.00]	0.02 [0.01; 0.03]*	0.01 [0.00; 0.01]	0.04 [0.03; 0.06]*	0.01 [0.01; 0.02]
Urethral stricture/urinary tract obstruction/hematuria	0.04 [0.02; 0.08]*	0.00 [0.00; 0.00]	0.17 [0.12; 0.23]*	0.01 [0.01; 0.02]	0.14 [0.10; 0.19]*	0.02 [0.01; 0.02]
Cancer in bladder or urethra	0.02 [0.01; 0.06]*	0.00 [0.00; 0.00]	0.11 [0.07; 0.18]*	0.01 [0.00; 0.01]	0.18 [0.12;0,27]*	0.01 [0.01; 0.01]
Dehydration	0.01 [0.01; 0.02]*	0.01 [0.00; 0.01]	0.07 [0.06; 0.09]*	0.05 [0.04; 0.05]	0.01 [0.00; 0.02]*	0.00 [0.00; 0.01]
Sepsis	0.01 [0.01; 0.03]*	0.00 [0.00; 0.00]	0.17 [0.13; 0.21]*	0.03 (0.03; 0.03]	0.01 [0.00; 0.05]*	0.00 [0.00; 0.00]

A Poisson model was used to predict utilization. BPH: benign prostatic hyperplasia; UTI: urinary tract infection; -: too few data to calculate; *Significantly different from matched control group (p < 0.000); **Significantly different from matched control group (p < 0.005).

Table 5. Predicted inpatient and outpatient mean costs in EUR per patient-year of bladder complications for case and matched control groups.

	Inpatient costs, mean [95% CI]		Outpatient costs, mean [95% CI]
	Case group	Control group	Case group	Control group
	BPH
UTI cluster	479 [456; 504]*	31 [31; 32]	36 [34; 37]*	1 [1; 1]
Urosepsis	209 [199; 220]*	13 [13; 13]	3 [2; 3]*	0 [0; 0]
Upper UTI	33 [31; 35]*	1 [1; 1]	0 [0; 0]*	0 [0; 0]
Lower UTI	139 [133; 146]*	11 [11; 11]	31 [30; 33]*	1 [1; 1]
UTI, site unspecified	98 [93; 103]*	7 [7; 7]	2 [2; 2]*	0 [0; 0]
Kidney disease	158 [150; 166]*	38 [38; 39]	321 [305; 337]*	73 [72; 74]
Stones in urinary tract or kidney	38 [36; 40]*	9 [9; 9]	22 [21; 23]*	5 [5; 5]
Urethral stricture/urinary tract obstruction/hematuria	120 [114; 126]*	12 812; 12]	69 [65; 72]*	6 [6; 6]
Cancer in bladder or urethra	87 [83; 92]*	19 [19; 19]	49 [46; 51]*	7 [7; 7]
Dehydration	41[39; 43]*	19 [18; 19]	2 [2; 2]*	0 [0; 0]
Sepsis	121 [116; 128]*	31 [30; 31]	1 [1; 1]*	0 [0; 0]
	Other non-neurogenic causes
UTI cluster	434 [411; 458]*	25 [24; 25]	62 [59; 66]*	2 [2; 2]
Urosepsis	186 [176; 196]*	8 [8; 9]	-	-
Upper UTI	27 [26; 28]*	3 [3; 3]	17 [16; 18]*	0 [0; 0]
Lower UTI	118 [112; 125]*	7 (7; 8]	42 [40; 44]*	1 [1; 1]
UTI, site unspecified	104 [98; 109]*	6 [6; 6]	2 [2; 3]*	0 [0; 0]
Kidney disease	158 [149; 166]*	23 [22; 23]	248 [235; 261]*	65 [64; 66]
Stones in urinary tract or kidney	26 [25; 28]*	6 [6; 7]	14 [13; 15]*	5 [5; 5]
Urethral stricture/urinary tract obstruction/hematuria	114 [108; 120]*	11 [11; 11]	43 [41; 46]*	6 [6; 6]
Cancer in bladder or urethra	134 [127; 141]*	8 [7; 8]	71 [67; 75]*	3 [3; 3]
Dehydration	47 [45; 50]*	20 [20; 21]	1 [1; 1]*	1 [1; 1]
Sepsis	152 [144; 161]*	25 [25; 26]	1 [1; 1]*	0 [0; 0]

A two-step one-model GLM regression model was used to predict costs. BPH: benign prostatic hyperplasia; CI: confidence interval; UTI: urinary tract infection; -: too few data to calculate; *Significantly different from matched control group (p < 0.000).

Figure 4. Predicted mean income transfer payments in EUR per patient-year for case and matched control groups. All differences between case and their matched control groups are significant (p < 0.000; however, for unemployment benefit p < 0.010). Please refer to Table S11 for confidence intervals.

A 2-step one-model GLM regression model was used to predict costs. BPH: benign prostatic hyperplasia.