Economic Cost of Fecal Incontinence

BACKGROUND: Despite its prevalence and deleterious impact on patients and families, fecal incontinence remains an understudied condition. Few data are available on its economic burden in the United States. OBJECTIVE: The aim of this study was to quantify per patient annual economic costs associated with fecal incontinence. DESIGN: A mail survey of patients with fecal incontinence was conducted in 2010 to collect information on their sociodemographic characteristics, fecal incontinence symptoms, and utilization of medical and nonmedical resources for fecal incontinence. The analysis was conducted from a societal perspective and included both direct and indirect (ie, productivity loss) costs. Unit costs were determined based on standard Medicare reimbursement rates, national average wholesale prices of medications, and estimates from other relevant sources. All cost estimates were reported in 2010 US dollars. SETTINGS: This study was conducted at a single tertiary care institution. PATIENTS: 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. MAIN OUTCOME MEASURES: The primary outcome measured was the per patient annual economic costs associated with fecal incontinence. RESULTS: The average annual total cost for fecal incontinence was $4110 per person (median = $1594; interquartile range, $517-$5164). Of these costs, direct medical and nonmedical costs averaged $2353 (median, $1176; interquartile range, $294-$2438) and $209 (median, $75; interquartile range, $17-$262), whereas the indirect cost associated with productivity loss averaged $1549 per patient annually (median, $0; interquartile range, $0-$813). Multivariate regression analyses suggested that greater fecal incontinence symptom severity was significantly associated with higher annual direct costs. LIMITATIONS: This study was based on patient self-reported data, and the sample was derived from a single institution. CONCLUSIONS: Fecal incontinence is associated with substantial economic cost, calling for more attention to the prevention and effective management of this condition.