To evaluate the economic burden of urinary incontinence among prostate cancer survivors using nationally representative data, focusing on differences in healthcare expenditures and utilization between survivors with and without incontinence.

We conducted a cross-sectional analysis using 2016-2021 data from the Medicare Expenditure Panel Survey. Men with self-reported prostate cancer were categorized by incontinence status. The primary outcome was the likelihood of incurring above-average total healthcare expenditures. Secondary outcomes included expenditures by care setting and frequency of outpatient visits. Survey-weighted multivariable logistic regression models were utilized to analyze expenditures, adjusting for age, race, insurance status, and education level.

The final weighted study population represented 3,060,848 prostate cancer survivors (76,759 with incontinence and 2,984,089 without). Survivors with incontinence were more often uninsured (8.9% vs 1.1%; P=.004) and less likely to have private insurance (2.5% vs 14.7%; P=.004). After adjustment, incontinence was associated with higher odds of above-average total expenditures (adjusted odds ratio [aOR] 2.33; 95% confidence interval [CI] 1.18-4.60; P=.015), largely driven by outpatient visits (aOR 3.81; 1.76-2.76; P=.001), outpatient expenditures (aOR 2.46; 95% CI 1.10-5.50; P=.029) and other non-facility-related expenditures (aOR 2.43; 95% CI 1.17-5.08; P=.018). Survivors with incontinence averaged 9 outpatient visits annually versus 6 among those without incontinence (P=.015).

Urinary incontinence significantly increases healthcare utilization and expenditures among prostate cancer survivors, particularly through outpatient care and incontinence-related medical supplies. Targeted strategies to prevent and manage incontinence may reduce long-term economic burden and improve survivorship care.