Fall/Fracture-Related Healthcare Costs and Their Association with Cumulative Anticholinergic Burden in People with Overactive Bladder

Abstract

Background Falls/fractures are major causes of morbidity and mortality among older adults and the resulting health consequences generate a substantial economic burden. Risk factors are numerous and include overactive bladder (OAB) and anticholinergic use. Objectives We aimed to estimate the impact of falls/fractures on all-cause healthcare resource utilization and costs, according to levels of cumulative anticholinergic burden, among individuals with OAB. Methods Among a US cohort of adults with OAB (identified based on medical claims for OAB or OAB-specific medications), the frequency of resource utilization (outpatients visits, medication use, and hospitalizations) was examined according to level of anticholinergic burden. Anticholinergic burden was assessed cumulatively using a published measure, and categorized as no, low, medium, or high. Resource utilization prior to and after a fall/fracture was compared. Generalized linear models were used to examine overall and incremental changes in healthcare resource utilization and costs by fall/ fracture status, and annual costs were predicted according to age, sex, fall/fracture status, and level of anticholinergic burden. Results The mean age of the OAB cohort (n = 154,432) was 56 years, 68% were female, and baseline mean anticholinergic burden was 266.7 (i.e. a medium level of burden); a fall/fracture was experienced by 9.9% of the cohort. All estimates of resource utilization were higher among those with higher levels of anticholinergic burden, regardless of fall/fracture status, and higher for all levels of anticholinergic burden after a fall/fracture. Among those with a fall/fracture, the highest predicted annual costs were observed among those aged 66-75 years with high anticholinergic burden (US$22,408 for males, US$22,752 for females). Conclusions Falls/fractures were associated with higher costs, which increased with increasing anticholinergic burden.

The Costs and Healthcare Resource Utilization Associated with Anticholinergic Burden in Long-Stay Nursing Home Residents with Overactive Bladder in the US

“…Despite differences in study populations, these findings are largely in line with previous observations that healthcare resource utilization among community-dwelling adults with OAB increased with higher levels of anticholinergic burden [36]. Lozano-Ortega et al found that among commercially insured OAB patients in the US, approximately 65% of individuals had some level of anticholinergic burden [36]. Significantly greater healthcare resource utilization was observed among those with any level of anticholinergic burden (low, moderate, or high) versus those with no burden.…”

“…Significantly greater healthcare resource utilization was observed among those with any level of anticholinergic burden (low, moderate, or high) versus those with no burden. Indeed, the relationships reported by Lozano-Ortega et al between level of anticholinergic burden and healthcare costs were more consistently linear than the relationships in the present study, where costs and utilization were at times observed to peak with moderate levels of burden [36]. However, although there was variability in healthcare costs across anticholinergic burden groups in the present study, healthcare costs were generally higher among those with higher anticholinergic burden.…”

A 12-Year Retrospective Study of the Prevalence of Anticholinergic Polypharmacy and Associated Outcomes Among Medicare Patients with Overactive Bladder in the USA

“…Demographics were observed during year 1 and included age category, sex, census region, nursing home category, and calendar year. Medical conditions included those associated with a higher risk of falls and fractures from Szabo et al [19] (e.g., Parkinson's disease, dementia, hypertension, and diabetes), Elixhauser comorbidities [14,24], and conditions indicated for treatment with an anticholinergic medication (Fall/fracture-related diagnostic codes: Predictive margins and average marginal effects on the original scale (i.e., probability, dollars) and their 95% CIs as well as relative risks were calculated from each regression model. Estimated standard errors were adjusted to be robust to heteroskedasticity of unknown form and for multiple yearly observations per person.…”

“…One study found that among commercially insured patients with OAB in the USA, approximately 65% had some level of anticholinergic burden. Furthermore, healthcare resource utilization and costs directly increased with a higher level of anticholinergic burden [ 14 ]. Likewise, a study of 3344 community-dwelling older adults found that increasing levels of anticholinergic burden were also associated with higher costs [ 15 ].…”

Increased Healthcare Resource Utilization and Direct and Indirect Costs in Patients with Depression and Comorbid Overactive Bladder: Evidence From a Retrospective, Matched Case–Control Cohort Analysis

“…Finally, while this study did not attempt to quantify the effect of anticholinergic burden on the outcomes herein, it should be noted that both OAB and depression are frequently treated with anticholinergics [ 25 , 26 ]. Studies have linked long-term anticholinergic use with dementia [ 27 ] and falls and fractures [ 28 ] and have noted concomitant increases in costs and resource use [ 29 ]. As such, it is possible that the increase in costs identified here could, in some measure, be the result of anticholinergic burden, particularly if patients are using drugs of that class to treat both conditions.…”