An analysis of factors that influence patient preference of third‐line therapy for overactive bladder

Kapur, Anjali; Harandi, Arshia Aalami; Cohen, Tal; Ruan, Heng; Dabrowski, Colin; Anderson, Rebecca; Hwang, Kuemin; H, Lee; Weissbart, Steven; Kim, Jason

doi:10.1002/nau.25046

Cited by 3 publications

(4 citation statements)

References 15 publications

(31 reference statements)

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“…In contrast, the current study was designed to evaluate a larger, more diverse sample of OAB patients compared to the prior study. The educational counseling on OAB therapies in the current study was provided within the survey as reading material rather than through a video interface as done in the prior study 4 …”

Section: Discussionmentioning

confidence: 99%

“…The educational counseling on OAB therapies in the current study was provided within the survey as reading material rather than through a video interface as done in the prior study. 4 In the first stage of our study, we investigated patient preferences for third-line therapies as currently delineated within the AUA/SUFU guidelines through text and pictorial descriptions of each therapy. Compared to our prior data on these preferences, this study found a similar pattern of patient preferences for third-line therapies, with BTX-A and PTNS having similar rates of interest, and SNM being chosen by fewer participants.…”

Section: Discussionmentioning

confidence: 99%

“…After watching an educational video on the pros and cons of each treatment during an office visit, they were given a survey that evaluated the most and least appealing features of each therapy. We found that BTX‐A was least attractive for its potential need for self‐catheterization in the setting of urinary retention, SNM was least attractive to patients due to the need for an implanted device, and PTNS was least attractive due to the need for frequent office visits for maintenance therapy 4 . Additionally, long‐term PTNS compliance has been reported to be as low as 39.5% at 12 months 5 .…”

Section: Introductionmentioning

confidence: 96%

“…We found that BTX-A was least attractive for its potential need for self-catheterization in the setting of urinary retention, SNM was least attractive to patients due to the need for an implanted device, and PTNS was least attractive due to the need for frequent office visits for maintenance therapy. 4 Additionally, long-term PTNS compliance has been reported to be as low as 39.5% at 12 months. 5 This better explains the reasons for poor followthrough with third-line therapy in patients who fail or are intolerant of OAB medications and further elucidates the need for alternative treatment modalities.…”

Section: Introductionmentioning

confidence: 99%

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Shifts in patient preference of third‐line overactive bladder therapy after introduction of the implantable tibial nerve stimulator

Kapur,

Aalami Harandi,

Hartman‐Kenzler

et al. 2024

Neurourology and Urodynamics

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IntroductionThird‐line therapies for overactive bladder (OAB) that are currently recommended include intravesical Onabotulinumtoxin‐A injections (BTX‐A), percutaneous tibial nerve stimulation (PTNS), and sacral neuromodulation (SNM). The implantable tibial nerve stimulator (ITNS) is a novel therapy that is now available to patients with OAB.ObjectiveThe objective of this study was to analyze shifts in patient preference of third‐line therapies for OAB after introducing ITNS as an option among the previously established therapies for non‐neurogenic OAB.MethodsA survey was designed and distributed via SurveyMonkey to the platform's audience of U.S. adults of age 18 and older. Screening questions were asked to include only subjects who reported symptoms of OAB. Descriptions of current AUA/SUFU guideline‐approved third‐line therapies (BTX‐A, PTNS, and SNM) were provided, and participants were asked to rank these therapies in order of preference (stage A). Subsequently, ITNS was introduced with a description, and participants were then asked to rank their preferences amongst current guideline‐approved therapies and ITNS (stage B). Absolute and relative changes in therapy preferences between stage A and stage B were calculated. Associations between ultimate therapy choice in stage B and participant characteristics were analyzed.ResultsA total of 485 participants completed the survey (62.5% female). The mean age was 49.1 ± 36.5 years (SD). The most common OAB symptoms reported were urgency urinary incontinence (UUI) (73.0%) and urinary urgency (68.0%). 29.2% of patients had tried medication for OAB in the past, and 8.0%–10.3% of patients were previously treated with a third‐line therapy for OAB. In stage A, participants ranked their first choice of third‐line therapy as follows: 28% BTX‐A, 27% PTNS, and 13.8% SNM. 26.6% of participants chose no therapy, and 4.5% chose all three equally. In stage B, participants ranked their first choice as follows: 27.6% BTX‐A, 19.2% PTNS, 7.8% SNM, and 19.2% ITNS. 21.9% of participants chose no therapy and 4.3% chose all four equally as their first choice. There were both absolute and relative declines in proportions of patients interested in BTX‐A, SNM, and PTNS as their first choice of third‐line therapy with the introduction of ITNS. Patients originally interested in PTNS in stage A had the greatest absolute change after the introduction of ITNS with 7.8% of participants opting for ITNS in stage B. Those interested in SNM in stage A had the largest relative change in interest, with 43.5% of those originally interested in SNM opting for ITNS in stage B. Finally, with the introduction of ITNS, the number of participants initially not interested in any third‐line therapy declined by an absolute change of 4.7% and relative change of 17.6%. Participants experiencing concurrent stress urinary incontinence (SUI) symptoms were more likely to choose a current guideline‐approved third‐line therapy than ITNS or no therapy at all (p = 0.047). Those who had prior experience with third‐line therapies were more likely to choose a third‐line therapy other than ITNS as their ultimate choice of therapy in stage B. Of those who had chosen a guideline‐approved third‐line therapy in stage B (not ITNS), 13.6% had prior experience with BTX‐A, 14.7% with PTNS, and 32 (11.2%) with SNM (p < 0.001, p < 0.001, p = 0.009, respectively).ConclusionFrom our study, it appears that ITNS may attract a subset of patients who would not have otherwise pursued current guideline‐approved third‐line therapies for OAB. When patients are provided with descriptions of third‐line OAB therapies including ITNS as an option, ITNS appears to compete with SNM and PTNS. It is possible that ITNS will provide patients with a different phenotype of neuromodulation therapy that can appeal to a niche OAB population. Given that ITNS devices have been introduced relatively recently to the market, their application will largely depend on cost and payer coverage, provider bias, and patient comorbidities. Further study is needed to understand how these factors interact with and influence patient preference of advanced OAB therapy to understand which patients will most benefit from this treatment modality.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%