The economic impact of incontinence in Australia Continence Foundation of Australia 2011 The economic impact of incontinence in Australia Contents Glossary ..................................................................................................................................... i Acknowledgements.................................................................................................................. iii Executive Summary .................................................................................................................. iv 1 Background and methods ............................................................................................... 1 1.1 Literature searches ........................................................................................................... 1 2 Epidemiology of incontinence in Australia ....................................................................... 2 2.1 Definition and pathogenesis of incontinence ..................................................................... 2 2.2 Risk factors and comorbidity ............................................................................................. 2 2.3 Mortality........................................................................................................................... 3 2.4 Prevalence ........................................................................................................................ 3 2.5 Prevalence projections to 2030 ......................................................................................... 9 3 Health costs .................................................................................................................. 13 3.1 Description ..................................................................................................................... 13 3.2 Methodology .................................................................................................................. 13 3.3 Health expenditure in 2010 ............................................................................................. 13 3.4 Projections to 2020 ......................................................................................................... 23 4 Other financial costs ..................................................................................................... 26 4.1 Productivity losses .......................................................................................................... 26 4.2 Informal care costs .......................................................................................................... 28 4.3 Community care costs ..................................................................................................... 29 4.4 Residential aged care ...................................................................................................... 31 4.5 Continence management products, including laundry costs ............................................. 32 4.6 Government assistance for continence management products ........................................ 34 4.7 Welfare payments........................................................................................................... 42 4.8 Deadweight losses from transfers ................................................................................... 43 4.9 Summary of other financial costs .................................................................................... 44 5 Burden of disease ......................................................................................................... 45 5.1 Methodology .................................................................................................................. 45 5.2 Burden of disease due to incontinence ............................................................................ 46 6 The total cost of incontinence in Australia ..................................................................... 48 6.1 Cost summary ................................................................................................................. 48 References .............................................................................................................................. 51 Appendix A : Literature searches ............................................................................................. 58 Appendix B : Prevalence of incontinence by severity of disease............................................... 59 Limitation of our work ............................................................................................................... 61 Deloitte Access Economics i The economic impact of incontinence in Australia Charts Chart 2.1 : Community dwelling population with incontinence, 2010 to 2030 ......................... 10 Chart 2.2 : RAC residents with incontinence, 2010 to 2030...................................................... 11 Chart 3.1 : Health system expenditure by payer, 2010 ($270.8 million) (a) .............................. 22 Chart 3.2 : Health system costs by modality, 2010 ................................................................... 23 Chart 3.3 : Incontinence health system costs, 2010 and 2020 .................................................. 25 Chart 6.1 : Components of total economic cost of incontinence in 2010 (total $66.7 billion) ... 49 Chart 6.2 : Total cost of incontinence by bearer, 2010 ............................................................. 50 Tables Table 2.1 : Potential data sources for incontinence prevalence estimates ................................. 4 Table 2.1 (Continued): Potential data sources for incontinence prevalence estimates ............... 6 Table 2.2 : Prevalence of urinary (assessed by ISI) and faecal incontinence (assessed by Wexner, excluding flatus ) in households, 2004 ......................................................................... 7 Table 2.3 : Aged Care Funding Instrument appraisal responses, June 2009 ................................ 9 Table 2.4 : Prevalence of urinary and faecal incontinence in 2010 and 2030, community and RAC populations ..................................................................................................................... 12 Table 3.1 : GP visits for incontinence (2010) ............................................................................ 14 Table 3.2 : Type of urinary and or bowel incontinence related GP visits and associated cost (2010) ..................................................................................................................................... 15 Table 3.3 : Number of GP referrals to medical specialists for incontinence per annum ............ 15 Table 3.4 : Medications prescribed by GPs for patients with incontinence (2010) .................... 17 Table 3.5 : GP referrals to allied health for urinary and bowel incontinence (2010) ................. 18 Table 3.6 : Pathology referrals by GPs for patients with urinary and/or bowel incontinence (2010) ..................................................................................................................................... 19 Table 3.7 : Medical imaging referrals by GPs for patients with urinary and/or bowel incontinence (2010) ................................................................................................................ 20 Table 3.8 : NCMS funding ........................................................................................................ 21 Table 3.9 : Health system expenditure by payer, 2010 ($ million) ............................................ 22 Table 3.10 : Health system costs - projections to 2020 ............................................................ 24 Table 4.1 : Employment rate of people with a disability who experience incontinence and difference with general, disabled population, 2003 ................................................................. 27 Table 4.2 : AWE for full-time and part-time employed in 2010 ................................................ 27 Table 4.3 : Productivity loss due to lower employment, 2010 .................................................. 27 Deloitte Access Economics ii The economic impact of incontinence in Australia Table 4.4 : Distribution of productivity losses, 2010 ($40.6 billion (a)) ..................................... 28 Table 4.5 : Proportion of package recipients needing help with incontinence and associated cost 30 Table 4.6 : Direct costs of continence care, selected nursing homes and hostels, 2001 and 201032 Table 4.7 : Median direct cost of urinary incontinence in women per week, Au$(a) .................. 33 Table 4.8 : Average cost per week for incontinence products (AU$) ........................................ 34 Table 4.9 : Summary of State and Territory support programs also providing continence management assistance .......................................................................................................... 37 Table 4.10 : Government assistance for continence management products 2010 .................... 42 Table 4.11 : Summary of other financial costs associated with incontinence in 2010 .............. 44 Table 5.1 : DALYs lost due to incontinence by disease severity in the community, 2010 .......... 47 Table 5.2 : Disability weights for urinary and faecal incontinence in the RAC population and DALYs lost by disease severity, 2010 ....................................................................................... 47 Table 6.1 : Summary of total cost of