Within pelvic floor disorders, urinary incontinence (UI) and overactive bladder (OAB) are relevant health problems confronting the rapidly aging of modern society; this holds true also from an economic perspective.

Systematise all the international available evidence on the burden of disease because of UI and OAB on society.

A systematic search of Medline and Embase databases was conducted on June 30th, 2008, aimed at retrieving studies concerning the cost of UI and OAB, any time. Results: Out of 161 abstracts retrieved, 25 studies were included in the review. Key findings emerged from the review process: (i) prevalence rates vary depending upon definitions used, populations studied, and methods employed, (ii) estimates of direct healthcare costs should take into account the hidden nature of incontinence since the most affected individuals do not seek treatment, (iii) biases may occur when estimating the burden of disease using claims data as these concern only people seeking care and treated for their symptoms, and (iv) direct costs of incontinence would likely be higher, if a greater proportion of patients with UI and/or OAB sought care. From an economic perspective, investing more resources in early diagnosis and initial treatment could potentially reduce the costs of treating late-stage disease and its consequences. This study illustrates also that healthcare systems never pursued clearly this direction: in OAB communitydwellers the cost of diagnosing and treating is less than the cost of treating its related consequences (e.g. skin irritations, urinary tract infections, falls), 29% and 48.4% of direct costs respectively. Whilst in UI community-dwellers, the cost of treating consequences is still high, being 18.2% of direct costs.

UI and OAB are associated with significant cost to the individual, institution and society. Understanding the magnitude of the impact of these pelvic floor disorders is important to health care providers, payers, and public policymakers in establishing health care priorities, taking advantage of potential savings, and allocating scarce resources for its appropriate management.