Impact of Coexisting Overactive Bladder in Medicare Patients With Dementia on Clinical and Economic Outcomes

Caplan, Eleanor O.; Abbass, Ibrahim M.; Suehs, Brandon T.; Ng, Daniel; Gooch, Katherine; Amerongen, Derek van

doi:10.1177/1533317519841164

Cited by 6 publications

(8 citation statements)

References 27 publications

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“…The finding that comorbid OAB increases depression-related costs echoes the findings of the effects of comorbid OAB with other conditions. A recent study of HCRU and costs in a population with dementia and comorbid OAB also noted the comorbidity was associated with higher disease-specific costs [ 24 ]. 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 ].…”

Section: Discussionmentioning

confidence: 99%

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

et al. 2020

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Introduction This study sought to compare healthcare resource utilization (HCRU), costs, and workplace productivity among patients with depression, with and without overactive bladder (OAB). Methods This retrospective, case–control cohort analysis compares HCRU, costs, and workplace productivity among propensity score matched patients with depression and OAB (case cohort) and patients with depression without OAB (control cohort). Patients were aged 18 years or older, insured/on Medicare, and had diagnosed depression and an antidepressant medication claim pre index. First OAB-related event was index for cases; controls were assigned a proxy (study period 12 months). Comparisons of HCRU and costs and regression models assessed the relationship between OAB and costs. For the workplace productivity subset analyses cases and controls were balanced on baseline covariates for the short-term disability analyses but as they were unbalanced for the absentee analyses, multivariate regression analyses were used for this subset. Results The study criteria were met by 39,085 cases and 308,736 controls, from which, 37,997 patients were successfully matched 1:1 (mean age 55 years; 81% female). Most depression-related HCRU measures were similar across cohorts; however, outpatient visits, ER visits, and number of unique depression medications were significantly higher (all p < 0.05) among cases. Cases also had 13% higher total depression-related costs ( p < 0.0001). Total mean (standard deviation [SD]) depression-related costs were $1796 ($4235) for cases versus $1597 ($3863) for controls ( p < 0.0001). For workplace productivity (absentee data: cases [ n = 686], controls [ n = 642]; short-term disability data: cases [ n = 4395], controls [ n = 4433]) absentee outcomes were similar across cohorts. However, a higher percentage of cases used short-term disability benefits compared to controls (21.3% versus 16.9%; p < 0.0001) and cases experienced more case days (11.0 versus 8.6 mean days) and received higher mean payments than controls ($1226 versus $1033; p < 0.0001) in this subset. Conclusions OAB was associated with 13% higher depression-related costs and 4.4% more cases used short-term disability benefits. Electronic Supplementary Material The online version of this article (10.1007/s12325-020-01485-w) contains supplementary material, which is available to authorized users.

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Section: Discussionmentioning

confidence: 99%

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

et al. 2020

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“…Mild cognitive impairment prevalence is estimated at 15%–20% among those older than 60 years, with 15% progressing to dementia annually 58 . OAB and urinary incontinence are more prevalent and severe in patients with dementia, and the combination portends worse health outcomes 59 …”

Section: Special Scenariosmentioning

confidence: 99%

“…58 OAB and urinary incontinence are more prevalent and severe in patients with dementia, and the combination portends worse health outcomes. 59 The AUA OAB guidelines note that OAB treatment requires patients have adequate cognitive ability to engage in the treatment process and communicate treatment response. 7 However, data on various OAB treatments in cognitively impaired patients is lacking.…”

Section: Cognitive Impairmentmentioning

confidence: 99%

Third‐line therapy for overactive bladder in the elderly: Nuances and considerations

Zillioux

Slopnick

Vasavada

2022

Neurourology and Urodynamics

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Introduction: Overactive bladder (OAB) disproportionally affects older adults in both incidence and severity. OAB pharmacotherapy is often problematic in the elderly due to polypharmacy, adverse side effect profiles and contraindications in the setting of multiple comorbidities, and concerns regarding the risk of incident dementia with anticholinergic use. The burden of OAB in older patients coupled with concerns surrounding pharmacotherapy options should motivate optimization of nonpharmacologic therapies in this population. At the same time, several aspects of aging may impact treatment efficacy and decision-making. This narrative review critically summarizes current evidence regarding third-line OAB therapy use in the elderly and discusses nuances and treatment considerations specific to the population. Methods: We performed an extensive, nonsystematic evidence assessment of available literature via PubMed on onabotulinumtoxinA (BTX-A), sacral neuromodulation, and percutaneous tibial nerve stimulation (PTNS) for OAB, with a focus on study in elderly and frail populations.Results: While limited, available studies show all three third-line therapies are efficacious in older populations and there is no data to support one option over another. BTX-A likely has a higher risk of urinary tract infection and retention in older compared to younger populations, especially in the frail elderly. PTNS incurs the lowest risk, although adherence is poor, largely due to logistical burdens. Conclusion:Advanced age and frailty should not preclude third-line therapy for refractory OAB, as available data support their efficacy and safety in these populations. Ultimately, treatment choices should be individualized and involve shared decision-making.

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“…97 However, this does not mean that those with dementia and OAB should not be offered treatment, as these conditions commonly coexist, and when they do it may be associated with an increased risk of fractures, urinary infections, and overall healthcare utilisation. 98 While authors have reported on the clinical efficacy and safety of OAB anticholinergic therapy in patients with cognitive impairment or dementia 62,72,99 , this seems like an unnecessary risk as there are now several non-anticholinergic based OAB therapies which can be considered such as beta-3 agonists, neuromodulation (including tibial, sacral, or pudendal), and intravesical botulinum toxin. 4,5 Beta-3 agonists are an attractive alternative, as they are an oral medication that can be initiated by any healthcare provider.…”

Section: Implications For Practicementioning

confidence: 99%

The cognitive effect of anticholinergics for patients with overactive bladder

2021

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Overactive bladder (OAB) is often treated with medications with anticholinergic properties. The impact of this medication class on cognition and risk of dementia has been a frequent topic of study. Short-term randomised trials have demonstrated that oxybutynin leads to impaired memory and attention, however trials involving other OAB anticholinergics have not been shown to have significant impacts on short-term cognitive function. In contrast, large, population-based studies have generally found significant associations between anticholinergic medications (including those that studied OAB anticholinergics exclusively) and dementia.These studies must still be interpreted in the context of potential residual confounding (where increased OAB medication use due to prodromal urinary symptoms associated with dementia leads to the observed risk increase). The discordant results between short-term cognitive safety and long-term increased dementia risk may be explained by a high proportion of oxybutynin users in the dementia studies, or a study duration that was too short in the prospective clinical trials. When necessary, the cautious use of selected OAB anticholinergic agents with favorable physicochemical and pharmacokinetic properties and clinical trial evidence of cognitive safety may be appropriate in those with potential risk factors for cognitive impairment. Key points1. Short-term randomised clinical trials (most less than 4 weeks) have not shown significant cognitive impairment with OAB anticholinergics other than oxybutynin.2. There are very few long-term clinical studies (>3 months) on OAB anticholinergics and those that are available have conflicting results and are limited by methodological issues.3. Large observational studies of OAB anticholinergic use have shown they are associated with an approximately 20% increased relative risk of dementia, but residual confounding and reverse-causality cannot be ruled out.4. Elderly patients, and those with underlying mild cognitive impairment (or conditions that put them at risk for it) may be best served with alternative overactive bladder treatments; when necessary careful use of anticholinergics with favorable physicochemical and pharmacokinetic properties and cognitive safety data may be considered.

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Impact of Coexisting Overactive Bladder in Medicare Patients With Dementia on Clinical and Economic Outcomes

Cited by 6 publications

References 27 publications

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

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

Third‐line therapy for overactive bladder in the elderly: Nuances and considerations

The cognitive effect of anticholinergics for patients with overactive bladder

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