Anticholinergic Burden and Associated Healthcare Resource Utilization in Older Adults with Overactive Bladder

Abstract

Background Bladder anticholinergics are the most widely used drugs to treat overactive bladder (OAB) but can contribute to cumulative anticholinergic burden, which may be associated with adverse outcomes. Objective This study aimed to evaluate the association between cumulative anticholinergic burden and healthcare resource utilization (HRU) and costs in older adults with OAB. Materials and Methods This was a retrospective, observational study that used data from the UK Clinical Practice Research Datalink (CPRD) GOLD database. Participants were aged ≥ 65 years with ≥ 3 years of continuous enrolment before and ≥ 2 years after the index date (date of OAB diagnosis or first prescription for any OAB drug between 1 April 2007 and 31 December 2015). The primary endpoint was the association between cumulative anticholinergic burden (assessed using the Anticholinergic Cognitive Burden [ACB] scale during the 3-year pre-index period) and HRU (GP consultations, specialist referrals, urological tests, hospital admissions) over the 2-year post-index period. Results Data from 23,561 adults were included in the analysis. Mean (SD) ACB scores in the pre- and post-index periods were 1.0 (1.1) and 2.4 (1.7), respectively; urological drugs contributed most (58.8%) to the latter. For the primary endpoint, higher pre-index ACB scores were associated with higher post-index HRU and costs. Mean (SD) ACB scores in the post-index period were 1.2 (1.3) and 2.5 (1.7) in those treated with mirabegron (beta-3 agonist) or bladder anticholinergics, respectively. Limitations The generalizability of the results outside the UK is unclear. Conclusions In older adults with OAB, higher anticholinergic burden before initiating OAB drugs is associated with higher HRU and costs. When making treatment decisions in older adults, consideration should be given to assessing the existing anticholinergic burden and using OAB treatments that do not add to this burden. Supplementary Information The online version contains supplementary material available at 10.1007/s40266-021-00884-0.

The impact of anticholinergics on cognitive function in patients with neurogenic lower urinary tract dysfunction: A narrative review

“…Relevant to the discussion about OAB anticholinergics, people living with NLUTD have a significantly higher anticholinergic burden as a result of multiple medications; the mean anticholinergic cognitive burden scale score was 6.6 (standard deviation: 5.9) in a UK sample of people with NLUTD,[ 11 ] whereas older people who are diagnosed with OAB have an anticholinergic cognitive burden scale score of 2.4 (standard deviation: 1.7). [ 29 ]…”

Patterns of rates of mortality in the Clinical Practice Research Datalink

“…A common research area of Electronic Health Records (EHRs) research, including the use of CPRD, is the effect of diseases on mortality and it is therefore imperative to understand how mortality rates in a selected CPRD population compare with general population rates. The selection of cohorts on the requirement of individuals having been registered at a contributing GP practice for a specific length of time is commonplace within EHR research [5][6][7][8][9][10]. Sometimes referred to as research-quality follow-up, or lookback window, it is an observation period prior to the start of a subject's at-risk follow-up, ending at a date often referred to as the index date.…”