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Diane Newman: Welcome. My name is Diane Newman, and I'm the Medical Director of UroToday. And I'm really excited with my presenter here today, Doctor Philip Von Kerrebroeck. He is a urologist in the Netherlands and Vice Chair of the EAU Policy Office. And what he's going to present today is the European continent's health strategy. Welcome.

Philip Van Kerrebroeck: Thank you, Diane. Thanks for the introduction. Indeed, I'm an emeritus professor of urology at the University of Maastricht. But for two years now, I'm chairing this project for the European Association of Urology aiming at continence health in Europe. And as a logo for the campaign, we took Urge to Act because that really indicates what we want to achieve.

Of course, urge is a little hint to definitions in urology or in functional problems of the lower urinary tract in terms of urge. And urgency is an important element of the overactive bladder syndrome, which is a very important clinical issue. And Urge to Act is clearly indicating what we want to achieve with this campaign.

Diane Newman: Also, yes, you named this document Urge to Act, which I think is really a great title. And it is available online. So if anyone wants to access this, we'll put up at the end of this the URL so they can access it. OK?

Philip Van Kerrebroeck: Yeah. Well, just I think for the audience, it could be interesting to give a little bit of background of this project. Of course, the European Association of Urology is a major organization in the urological field and the biggest organization in Europe. The EAU has about 15,000 members. The majority of urologists from the different countries in Europe, not only the European Union, in the geographic Europe, but also from abroad. And the EAU regularly, at least once a year, has contact with the national societies to see what are the needs of urology within the European panorama.

And when they had the first meeting after the COVID times, it appeared that national societies were really struggling with non-oncological issues because in COVID times, of course, there was a priority to oncological issues. And after the COVID time, there were huge waiting lists, huge waiting times, and of course, oncological problems got even more priority to the detriment of non-oncological problems. So they said, really, the EU should aim at ameliorating the focus and the care for benign urological conditions.

Then at the second question, what is done within the large field of benign urological conditions? The primary topic then clearly continence health, or perhaps they expressed it as incontinence, came up. In the rest of the campaign, we rather like to talk about continence health because we want to be positive and show a perspective of reaching continence health and not talking about incontinence. It's also based on the fact that incontinence still has a certain taboo and a negative appeal. And that is very important.

Definitely, we will talk later about how to approach politicians and policymakers. It's important that we can bring, indeed, a positive message and an aim that is positive and does not bring them to a negative appeal that also is linked rather with quality of life, lifestyle, and not really as a serious medical problem. So that is already one of the important issues that we have to deal with in the field.

So then you ask me because I was just retired as a professor of urology. So I thought, well, he has been busy for more than 30 years in the field of functional problems of the lower urinary tract. So he has some knowledge about it. And I'm living actually in Antwerp, in Belgium, which is close to Brussels, where the European Administration and the European Parliament are located. So that's how I got into this.

And the EAU, since five years as a policy office aiming at having this contact with the European geographical area and definitely within the European Union, is, of course, focusing on activities in Brussels and aiming at policymakers to try to influence and put urological items on the European agenda.

Now, for the non-European listeners or viewers, it's important to realize that health care in the European Union is still a national matter. That means that European authorities have, in fact, no role to play in health care. On the other hand, as an overwhelming institutional body, the European Union authorities can put the framework for certain items, including health care, to which eventually national states can hook up or can take this into account.

And another issue is that European authorities have huge funds for research, also in medicine and health care. So these projects, then, of course, can be implemented in the different member states that are willing to participate in that. And as such, you can implant a seed that then hopefully will have an effect in some of the member states. But eventually, in the competition of the member states, there can still be a project that gets a broader appeal for the global European community. That's how things work.

But let's also note the complexity of dealing with European policymakers. But in a way, probably it's not that much different compared to the US situation where you have the federal, state, and the different individual states. So I think there are also some similarities in that respect.

Now, to expand a little bit on the policy field, it's important to realize that there are three authorities, in fact, within the European Union. You have the European Parliament, which, of course, is the legislative body, which is very important because they will have to vote on projects. They will have to vote on the allowance for sponsoring.

You have the European Commission, which you could say is the European government with different commissioners, one from each of the member states of the European Union, each of them with a specific field. And there is, indeed, also a commissioner for health that, of course, is the main responsible individual driving health care projects.

And then, of course, you have the third element, which is the European Council, which is the group of representatives of the different member states headed by the European President, who is an independently elected individual that is overseeing the different heads of state or the prime ministers of the different members of the European Union.

So if you want to influence policy at the European Union level, you have to deal with these three organizations because they have to be in line. As I said, health care is a national matter, so you have to deal with the European Council, with the member states. You have to deal with the Commission because there is the health commissioner that is kind of the minister for health within Europe. And you have to deal with the European Parliament that will vote on projects, will give the allowance for projects, and will allow for specific sponsoring of health care projects. So that is, let's say, the challenge in terms of dealing with the policy in the European environment.

Diane Newman: Well, thanks for that background. So the thing is that it's exciting, though, that you're addressing this because we know the cost of incontinence is really increasing. So do you want to give us some more information as far as exactly what this project was about, the background and that? And then what actually you guys found with the Urge to Act?

Philip Van Kerrebroeck: Yeah. Exactly, that's also an interesting story in a way that when I started two years ago, I started in a rather naive way, in a sense, of contacting on an individual basis members of the European Parliament just to start and to see how the field is, how people feel about it.

And that was a rather disappointing experience because when you come there as a medical doctor, even a specialist doctor and an emeritus professor, they look with a certain pity. And they say, what are you talking about? What is the problem?

And then very soon I realized that, in fact, what was lacking was data. And any politician will only move forward based on data. They don't move forward on medical information, or on stories, or on experience.

So then I did initial research into the literature, which was quite disappointing in terms of finding good epidemiological data, socioeconomic data. And so we said, well, we have to explore this further. This also relates to the fact that if you deal with policymakers, you have to work with specialist companies that can deliver these reports and that are trusted by European politicians.

If I would do the literature research and show this to the politicians, they will say, OK, very nice but this is just pleading for your own purpose. When this is a so-called independent commercial company, they have their authority and their relations with the European authorities. And then suddenly, this is trustworthy in a way.

So then we contacted a company which is situated in the UK, quite bizarre enough. As you know, the UK is not in the European Union anymore, but still there is quite intensive cooperation. And so we discussed with them to deliver us epidemiological and socioeconomic reports.

So in the beginning, I was alone, so I tried to find other people that could do the work with me. And in management terms, we call that stakeholders, of course. And the initial stakeholders of this project were, of course, the European Association of Urology, obviously, with entities, the Policy Office that I'm representing, but also the Patient Office.

Because the European Association of Urology has a very active Patient Office within the organization of the EU. And they're doing great work in terms of having the direct representation of the patient, bringing information to the patient, bringing input also in the scientific program of the annual meeting on behalf of the patients. And so they are, of course, an important element in this endeavor. So that is the EAU part.

We also were in contact with the International Continence Society as the international organization representing not only urologists, because, of course, the European Association of Urology is a urological organization. But as we know, continence health is not dealing only with urologists, but it's also a field dealing with gynecologists, physiotherapists, nurses, and other health care providers. So we thought that ICS was the perfect organization to represent the multidisciplinary approach of matters.

As a third organization, we had the World Federation of Incontinence of Pelvic Problems because they are an intrinsic and independent patient organization, again, with a worldwide view. And as a fourth initial stakeholder, the [INAUDIBLE], which is the representation of Spanish-speaking countries in urology and urogynecology. Because, of course, gynecology is also an important partner. So those were the initial stakeholders. And they gave input to us on what we should have in such a socioeconomic report.

Then we also obviously contacted all the national societies within the geographical Europe. So not only in the European Union, but in the geographical area of Europe. And we asked them about information that they would have on continence health in their individual country in terms of do you have epidemiological data, do you have data on global cost? And we also contacted health care providers, insurance companies, and ministries of health in the different countries of the European geographical area.

We gathered all this information together with a search in the literature and in published material, also, for example, the International Consultation on Incontinence Books that had an update, I think it was 2022, the latest version, and accumulated all this information. And this resulted in an epidemiological and socioeconomic report with data.

As a background, it's important to realize, because that already gives an indication on what will be our future aims and topics for implementation of the campaign, that good data on epidemiology and definitely on cost of continence health are very limited. The information that is there is not always of optimal quality. Quite often it's more than 10 years old. It's a bit outdated. Not always very reliable. So there is still a big lack of adequate information to have a good idea of the global epidemiological situation and even of the socioeconomic situation.

Having said that, there are also some positive signals. For example, some individual countries, for example, Poland, did great projects in recent years in terms of epidemiological studies. They had a very well-done epidemiological study that has been published in the literature that gives a very good idea on the prevalence and incidence of urinary incontinence problems in Poland, which can be representative for other countries.

Although, we have to realize that even within the European Union, there are significant differences from one country to another. Because, again, for non-EU citizens, we have the European Union. But each country is an entity in itself, definitely in terms of health care. There is a different insurance system. Reimbursements are different.

And for example, protective materials for urinary incontinence are fully reimbursed in several Western European countries, while in countries in Central and Eastern Europe, there is no reimbursement at all. So you can imagine that this has a significant impact on the quality of life for people with urinary incontinence problems, but also has an impact on the global cost of incontinence.

But in countries where there is no reimbursement, of course, these costs don't get calculated in the global health care cost. Although, of course, these costs impact on the individual people. So these are the important elements that we have to take into account.

So taking all this into account, I think that we came up with a very solid socioeconomic report also informing about epidemiological data. And I must say we were both at the International Continence Society meeting in Madrid two weeks ago. And after my talk on this project, I was approached by a representative of the Australian Continence Foundation.

And she said, OK, I like your talk. It's great information. And I'm so happy because your report really confirms a report that we have been making in Australia. And indeed, she sent it to me. And from my perspective, I'm very happy because their report confirms our report in terms of the data in terms of epidemiology but also the socioeconomic aspect.

This is a report done for Australia, which is quite a homogeneous situation, of course, but with quite similar data in terms of prevalence and incidence of urinary incontinence and also in terms of tangible costs, not only direct costs in terms of medication, protective material, but also indirect costs such as absenteeism, presenteeism, and costs around informal care of these patients.

So I think we have a solid report that I must say that in my contacts with members of the European Parliament and the European Administration, this is quite well appreciated and makes the talk with policymakers much easier. Because we have the data, we can show them what is really the problem. Because honestly, when you talk to policymakers, of course, they always will say that patients are the most important. But in the talks, what is driving them or what is an important driver is cost.

And so if you can present the data on the cost situation in terms of continence health, then they listen. Because there they can see an important aspect and an important aim for policy change.

Now, also, I'm part of the Policy Office of the European Association of Urology. And within the policy office, we are also dealing with oncological projects, of course. And one of the oncological projects is screening for prostate cancer, which is running for five years, quite successfully, got quite a big grant. And they're running trials in several member states of the European Union in terms of organized screening for prostate cancer, counteracting incidental prostate screening that is present in many countries of the European Union.

The criticism of policymakers on this project was, well, perhaps screening for prostate cancer is interesting and important, but there is a major risk that this will increase the cost of prostate cancer care.

Now, coming back to continence health, it's just the opposite. Because one of the important conclusions of the epidemiological and socioeconomic report is that we can indicate that there is an important possibility with policy change to reduce the cost.

On the other hand, without the change in policy, there will be a significant rise in the cost that can go up to 25% between '23 and the year 2030 if no policy change is implemented. So again, for policymakers, this, of course, is a very interesting thing that if they can reduce the cost by changing policy, well, there you have politicians listening to it.

So that is also one of the important aspects that we could show in this socioeconomic report. Because indeed, a little bit also to our surprise, because we had some idea of the cost, of course, but globally, the cost of continence health in the European Union—I'm speaking only European Union—has been calculated for the year 2023 at about 60 billion euros. So that's a trigger.

To put it in perspective, this is about half of the cost of diabetes care and is one third of the global cost of cancer care. So this is huge. It is really, really impressive. And if you show that again to politicians, of course, they have no idea of the global cost, not at the national level, but definitely not at the European level. But if you can show them indeed, really these are the costs, then again you have a listening ear of the politicians, especially since we are convinced, as I said before, that without policy change, this 60 billion will increase to 100 billion in the year 2030 without change in policy.

But on the other hand, by changing the policy, there is a possibility to control the cost and we think even to reduce the cost. Of course, it won't be an easy thing. It will not be a walk in the park. But definitely, it gives opportunities indeed to act. We think there is an urge to act to come back to the logo of our campaign.

Diane Newman: Yeah, the thing is, you're being proactive. I mean, now you know your costs. You know they're not going to go down. So now what are we going to do about it is what you're saying. Well, you want to go ahead to the presentation then. Because that was a great background on this.

Philip Van Kerrebroeck: Yeah.