Practice Patterns for Women With Overactive Bladder Syndrome: Time Between Medications and Third-Line Treatments

Abstract

Objective The aims of this study are to determine how long it takes female patients with overactive bladder (OAB) to receive third-line treatment after starting OAB medications and identify factors associated with increased time. Methods This was a retrospective observational cohort study of adult female patients with OAB who received third-line treatment between 2013 and 2015 using insurance claims databases. Primary outcome was time between first OAB medication and first third-line treatment. Additional variables were patient demographics, diagnostic tests, and medical comorbidities. Results Of 3232 patients included in this study, 48.8% underwent sacral neuromodulation, 31.6% percutaneous tibial nerve stimulation, and 23% intradetrusor onabotulinumtoxin A injections. Twenty-one percent of patients filled medication prescriptions for 3 or more antimuscarinic medications, 30.4% took mirabegron, and 32.3% had advanced diagnostic tests suggestive of a specialist evaluation prior to starting medications. Median time to third-line treatment was 37.7 (interquartile range, 14.9, 16.3) months. Adjusted linear regression model revealed 2 predominant predictors of time to third-line treatments: each antimuscarinic medication trial was associated with 5.3 (95% confidence interval, 4.4–6.3) more months before third-line treatment (P < 0.001), and advanced diagnostic evaluations prior to starting medications were associated with 28.2 (95% confidence interval, 21–35) fewer months before third-line treatment (P < 0.001). Conclusions Women with OAB who undergo third-line therapy do so on average more than 3 years after starting medications. Time to third-line treatment is largely driven by the number of antimuscarinic medications tried and timing of diagnostic evaluation by a specialist. Based on these results, we suggest providers consider limiting antimuscarinic trials to 2 medications prior to moving on to other treatment options.

A retrospective longitudinal evaluation of new overactive bladder patients in an FPMRS urologist practice: Are patients following up and utilizing third‐line therapies?

“…The use of telehealth for urology appointments is an up and coming prospect that may improve care for OAB. 21 Kirby et al 12 found that in women with OAB seeing any care provider for treatment, the median time to thirdline therapy is greater than 3 years. At our tertiary referral center with an FPMRS fellowship-trained urologist, the mean time pre-CCP for third-line therapy was 280 days; the use of a CCP nearly halved this time to 160 days.…”

“…While third‐line therapies such as sacral neuromodulation, intradetrusor onabotulinumtoxinA injections, and percutaneous tibial nerve stimulation (PTNS) are found to be more efficacious in managing OAB, a study found that only 2% of patients utilize said therapies 9–11 . Furthermore, women with OAB wait on average more than 3 years to undergo third‐line therapy 12 . Overall, patients with OAB demonstrated a poor understanding for OAB physiology, modalities of treatment, and dissatisfaction of care resulting in loss to follow‐up 13,14 …”

“…[9][10][11] Furthermore, women with OAB wait on average more than 3 years to undergo third-line therapy. 12 Overall, patients with OAB demonstrated a poor understanding for OAB physiology, modalities of treatment, and dissatisfaction of care resulting in loss to follow-up. 13,14 Clinical care pathways (CCP) are plans that detail the essential steps and track the progress of patients with a specific condition.…”

Overactive bladder medication prescription trends from 2014 to 2018

“…Growing literature on anticholinergics including the association with incident dementia has raised concern about their use. [4][5][6] Additionally, Kirby et al, 7 2020 demonstrated a relationship in the number of anticholinergics trialed and time to third line therapy. This may reflect a subset of patients with unaddressed symptoms and continued potential risks of different anticholinergics in a real-world setting.…”

Asynchronous telehealth visits for the treatment of overactive bladder

“…Data informing on the average time spent in follow-up visits specifically for the treatment of overactive bladder are largely lacking. Tai-Seale et al 14 demonstrated that in primary care setting, a median follow-up visit length was 15.7 minutes. This time frame seems to be consistent with our practice where patients with OAB are booked for 15-minute follow-up appointments.…”