Nocturnal enuresis: economic impacts and self-esteem preliminary research results.

Bedwetting is a common complaint, affecting approximately 10% of 7-year old children in the developed world and causing an economic drain on society. Not only is the cost of nocturnal enuresis borne by the families, but also by national health services and state health insurance. Although previous studies have examined the direct costs of nocturnal enuresis, the current paper also investigates the indirect costs to some selected families, such as the extra housework that is involved. The total cost of having an enuretic child was estimated on a case study basis in five countries with results being reported here for three countries (Sweden, UK and Germany). The study considered costs over a period of 3 months, with questionnaires on self-perceived self-esteem being included for the child. The critical factors influencing overall costs were the number of wet nights per week, necessitating washing and drying, and the costs of the treatment itself. Overall, the study found that total costs of not treating enuresis in heavy bedwetters can be higher than with any of the treatment alternatives, which must be seen as an additional burden to families with a child suffering from lower self-esteem.

What is an acceptable treatment outcome?

Nocturnal enuresis is a multifactorial condition and, as such, is accessible to a variety of treatment modalities. In order to evaluate and compare the efficacies of different treatments in patients with specific pathophysiologies, studies should describe fully the patient population under investigation. In addition, many of the studies conducted to date have applied different outcome measures, making comparisons difficult. Therefore, it is necessary to define standard outcome measures that should be used universally. These may relate to the effect of the treatment on the number of wet nights per week, the effect on the family economy of a reduction in the number of episodes of enuresis and the effect on the child's self esteem and/or quality of life.

[Enuresis and benign micturition disorders in childhood. II. Cost of the management]. / L'énurésie et les troubles mictionnels bénins de l'enfance. II. Coût de la prisé en charge.

The financial cost of bedwetting management is often underestimated. A study including 48 children aged 6 to 16 years was carried out in the outpatient clinic in order to evaluate the cost of these disorders during a 4 month-period. The diagnosis was the following: nocturnal enuresis (n = 15), bladder instability (n = 22) and other voiding dysfunction (n = 11). Our results showed that these expenses were quite important. A relationship between the kind of voiding dysfunction and the subsequent expenses was observed: the more complex was the disorder, the more expensive it was (average expenses = 1317 FF/year for nocturnal enuresis, 2506 FF/year for bladder instability and 3174 FF/year for other dysfunctions). Subsidiary expenses (transport, diapers and extrawashing) constituted an important part of the whole expenses: 46% in nocturnal enuresis, 42% in bladder instability and 38% in other dysfunctions.

[Costs of the treatment of enuresis nocturna. Health economic consequences of alternative methods in the treatment of enuresis nocturna]. / Omkostningerne ved behandling af enuresis nocturna. Samfundsøkonomiske konsekvenser af alternative metoder til behandling af enuresis nocturna.

The health economic consequences of treating nocturnal enuresis with a buzzer alarm is compared to treatment with Desmopressin. Based on age specific prevalence estimates and reported effects of the two treatments a cost-effectiveness analysis (CEA) was performed. The analysis showed a considerable difference between the costs of the two alternative treatments. A treatment based upon the buzzer alarm could result in a net saving to society of 19.2 million DKK, while a treatment based upon Desmopressin could result in expenses for society of 44.8 million DKK. A treatment based on a combination of the two will be economically neutral to the society. Treatment with a buzzer alarm or a combined treatment is therefore from a health economic point of view preferable. The health economic consequences of the introduction of new treatments are discussed, and it is recommended that health economic analyses are performed before the introduction of new treatments.