Inequities in Filled Overactive Bladder Medication Prescriptions in the US

Abstract

ImportanceAnticholinergic medications to treat overactive bladder (OAB) have been associated with increased risk of cognitive decline, whereas β3-adrenoceptor agonists (hereafter, β3-agonists) have comparable efficacy and do not carry the same risk. Yet, anticholinergics remain the predominant OAB medication prescribed in the US.ObjectiveTo evaluate whether patient race, ethnicity, and sociodemographic characteristics are associated with receipt of anticholinergic vs β3-agonist OAB medications.Design, Setting, and ParticipantsThis study is a cross-sectional analysis of the 2019 Medical Expenditure Panel Survey, a representative sample of US households. Participants included individuals with a filled OAB medication prescription. Data analysis was performed from March to August 2022.ExposureA prescription for medication to treat OAB.Main Outcomes and MeasuresThe primary outcomes were receipt of a β3-agonist or an anticholinergic OAB medication.ResultsAn estimated 2 971 449 individuals (mean age, 66.4 years; 95% CI, 64.8-68.2 years) filled prescriptions for OAB medications in 2019; 2 185 214 (73.5%; 95% CI, 62.6%-84.5%) identified as female, 2 326 901 (78.3%; 95% CI, 66.3%-90.3%) self-identified as non-Hispanic White, 260 685 (8.8%; 95% CI, 5.0%-12.5%) identified as non-Hispanic Black, 167 210 (5.6%; 95% CI, 3.1%-8.2%) identified as Hispanic, 158 507 (5.3%; 95% CI, 2.3%-8.4%) identified as non-Hispanic other race, and 58 147 (2.0%; 95% CI, 0.3%-3.6%) identified as non-Hispanic Asian. A total of 2 229 297 individuals (75.0%) filled an anticholinergic prescription, and 590 255 (19.9%) filled a β3-agonist prescription, with 151 897 (5.1%) filling prescriptions for both medication classes. β3-agonists had a median out-of-pocket cost of $45.00 (95% CI, $42.11-$47.89) per prescription compared with $9.78 (95% CI, $9.16-$10.42) for anticholinergics. After controlling for insurance status, individual sociodemographic factors, and medical contraindications, non-Hispanic Black individuals were 54% less likely than non-Hispanic White individuals to fill a prescription for a β3-agonist vs an anticholinergic medication (adjusted odds ratio, 0.46; 95% CI, 0.22-0.98). In interaction analysis, non-Hispanic Black women had an even lower odds of filing a β3-agonist prescription (adjusted odds ratio, 0.10; 95% CI, 0.04-0.27).Conclusions and RelevanceIn this cross-sectional study of a representative sample of US households, non-Hispanic Black individuals were significantly less likely than non-Hispanic White individuals to have filled a β3-agonist prescription compared with an anticholinergic OAB prescription. These differences may reflect an inequity in prescribing behaviors promulgating health care disparities. Targeted research should assess the relative contribution of a variety of individual and societal factors.

A Comparison of U.S. Individual and Family Plan Medication Coverage for Overactive Bladder

“…While the literature evaluating coverage trends for OAB medications is limited, prior studies have shown higher out-of-pocket costs for beta-3 agonists compared with anticholinergics consistent with the findings in this study. Luchristt et al 23 demonstrated a median out-of-pocket cost for 1 insurer of $45 per fill for beta-3 agonists versus $9.78 for anticholinergics. They also showed that fulfillment of beta-3 agonist medications is disproportionately low in non-Hispanic African American populations compared with White populations suggesting that these coverage trends likely further exacerbate known inequalities in health care.…”

“…They also showed that fulfillment of beta-3 agonist medications is disproportionately low in non-Hispanic African American populations compared with White populations suggesting that these coverage trends likely further exacerbate known inequalities in health care. 23 In their evaluation of Medicare beneficiaries, Shapiro et al 24 similarly reported differences for coverage for generic anticholinergics with total yearly costs for IR n AUGS SPECIAL ISSUE SUBMISSION…”