Getting a good night’s sleep can do wonders. Nevertheless, there are many who struggle to make it happen – for various reasons. It’s easy to recognise: you’ve settled into bed, sleep creeps up, but then … just one last round of toilet before you fall asleep. For women with an overactive bladder, one extra trip to the toilet is often not enough. It can quickly be a matter of two, three, four or five rounds every single night. – For some, this is a disabling problem. Just going out for a walk becomes difficult without knowing that you have a toilet available at all times, says Gudrun Veske. She is head of department at Levanger Hospital in Trøndelag. Here they offer botox treatment for women who struggle with an overactive bladder. But even if the need is great, this is not a treatment that is profitable for the hospital. Overactive bladder and botox treatment The reason why women can struggle with what is called an overactive bladder is due to a disturbance of the nervous system. This disorder causes the bladder muscle to contract more often than normal. This in turn can cause involuntary leakage of urine. In patients where drugs and training the bladder do not produce a good enough effect, treatment with botox can be tried. Botox (Botulinumtoxin) is a chemical substance produced by soil bacteria. When you inject this into the bladder muscle, you get a partial paralysis of the muscle, which in many people can make the problems smaller. The effect only comes after a couple of weeks, but can last for 4–8 months. Source: Sykehuset Levanger Many in line At the hospital in Levanger, nurses Marie Johansen and Kjersti Finstad are at work. They have just sent one patient home, and will soon be ready for the next one. – The patients are already examined before they come here, so I first take them into a room and put anesthetic in the bladder, says Johansen. In the meantime, Finstad has prepared the Botox. They usually insert ten stitches into the bladder wall. In addition to the two nurses, there is also a senior doctor involved in the procedure. Normally, the hospital has one botox day a month. But more and more people will have treatment, say the nurses. – Now we have actually had two days in a row, because the pressure is great. It’s also because of the summer holidays, because then we haven’t had offers, says Finstad. Nurses Marie Johansen and Kjersti Finstad work at Levanger Hospital. They find that the vast majority of patients think the procedure is straightforward, without too much pain. Photo: Julie Haugen Egge/news Life-changing Around 20 per cent of the population may experience such ailments. Most are women, and the incidence increases with age. – Many of those who are struggling do not want to go out among people because they urinate on themselves. That’s what Kristine Fuglen Ulstad, senior physician at the gynecology department at Levanger Hospital, says. She says that for many, the treatment has changed their lives. How long the injections last varies from patient to patient, and they must call the hospital themselves when they need a refill of Botox. It can vary from four months to up to a year. – Then it can be many months before they get a new appointment. This is because we do not have free capacity, says department manager Ulstad. Kristine Fuglen Ulstad says the botox treatment means a lot to many of the patients’ quality of life. Photo: Trondheim gynecologists Not profitable – What we see is that there is a crying need, but it is not profitable for the hospital to provide the treatment. The reimbursement is too low considering the number of resources used. But we choose to focus on women’s health, which in this case clearly improves the quality of life, says department head Gudrun Veske. Reimbursement is the sum the hospital receives back from the state for offering the treatment. At Oslo University Hospital, they have also thought about this. – The hospital will be reimbursed NOK 1,700 for the treatment. It does not cover the price of the medicine, which costs over NOK 2,000. In addition, employees must be paid and disposable equipment paid for. That’s what Ole Jacob Nilsen says. He is section leader at the hospital’s urology department. – It has been a theme since this came out, that it costs much more than you get back. Ole Jacob Nilsen is section leader at the urology department at Oslo University Hospital. Photo: Ine Eriksen, / UiO Want a reassessment – But we do not control our treatment according to whether we make money from it or not. We cannot refrain from providing treatment even if it is not financially beneficial, says Nilsen further. The doctor believes that the reimbursement price should be reassessed. He says the group of patients who struggle with incontinence are given lower priority in a pressured healthcare system. Norwegian hospitals are run according to the enterprise model. This means that they are owned by companies which in turn are owned by the state. They get a lot of their income from treatment they carry out, which have different price tags. The hospitals are not supposed to make a lot of money, but the state makes demands that they must have money on their books. Investments and developments are financed by the hospital’s surplus, and therefore it is important for a hospital not to run into a deficit. At St. Olav’s hospital in Trondheim, they also offer the treatment. Thorbjørn Dahl is clinic manager at the Surgical Clinic. He says they carry out approximately 300 treatments a year. – Costs for Botox, equipment and personnel are not covered by the current rate. About half of the treatment has to be done as day surgery, and this results in higher costs for outpatient treatment. There may be a change When the Norwegian Directorate of Health decides on reimbursement arrangements, they start from a rather complex system. It is called the DRG system. The hospitals themselves calculate what the various treatments (DRG) cost. The Norwegian Directorate of Health calculates average national costs. It is not intended that the refunds should cover all the costs, but on average 40 per cent, explains Eva Wensaas. She is head of the department for funding in the Norwegian Directorate of Health. She points out that there are still variations. Wensaas says they have received a lot of feedback from hospitals and healthcare organizations about the treatment in question. – The system is in continuous development, based on input from various actors. In this current case, we will assess the need for change from 2024. This is based on input from the sector in 2023, she tells news. – Very sad Senior doctor Kristine Fuglem Ulstad thinks it’s sad that the important treatment leads to low reimbursement for the hospital. – There is a group of patients who can be very disabled, and it is a very simple treatment that can change their lives completely. – If we hadn’t had the opportunity to offer the treatment due to finances, I think it would have been very sad, she says.
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Many women are queuing to get Botox in the bladder – hospitals are losing money on providing the treatment – news Trøndelag – Local news, TV and radio
