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

Abstract

Background Overactive bladder (OAB) is a prevalent condition commonly treated with anticholinergic medications. The extent to which anticholinergic burden is associated with costs and healthcare resource use (HCRU) in the long-stay nursing home (LSNH) setting is currently unknown. Objectives This research evaluated the impact of anticholinergic burden on HCRU and related costs among LSNH residents with OAB. Methods This was a cohort study based on 2013-2015 Minimum Data Set-linked Medicare claims data involving LSNH residents aged ≥ 65 years with OAB and having Parts A, B and D coverage 6 months pre-and ≥ 12 months post-nursing home admission date (index date). Cumulative anticholinergic burden was determined using the Anticholinergic Cognitive Burden scale and defined daily dose. Direct medical costs related to HCRU were examined. HCRU included inpatient, outpatient, emergency room (ER), and physician office visits. Costs and HCRU associated with levels of anticholinergic burden were evaluated using generalized linear models. Results A total of 123,308 LSNH residents with OAB were included in this study. Most residents (87.2%) had some level (12.8%, none; 18.0%, low; 41.9%, moderate; and 27.3%, high) of cumulative anticholinergic burden. Results indicate that all types of resource utilization were higher among those with any level of anticholinergic burden than those with no burden. The outpatient, ER, and physician costs tended to be higher with increasing anticholinergic burden. Conclusions Costs and HCRU patterns reflected increasing trends with anticholinergic burden. Targeted efforts towards reducing anticholinergic burden among LSNH residents with OAB may result in decreases in costs and HCRU.

Urinary incontinence and its associated factors in nursing home residents: a multi-centre cross-sectional study in Central Catalonia

“…of incontinent residents in our study took drugs for the urinary tract (group G). Therefore, our main hypothesis to explain the association with UI relates to adverse effects associated with anticholinergic activity which affect up to 87% of NH residents (41). The use of anticholinergic medications has been associated with cognitive decline, which in turn may lead to continence decline, as discussed previously (42).…”

“…Drugs with anticholinergic activity are used for the treatment of many prevalent conditions in NHs such as mental diseases, pain or even overactive bladder, a common cause of UI in NHs (41). However, only 6%…”

Prevalence of urinary incontinence and associated factors in nursing homes: a multicentre cross-sectional study

“…Drugs with anticholinergic activity are used for the treatment of many prevalent conditions in NHs such as mental diseases, respiratory disorders or even overactive bladder, a common cause of UI in NHs [ 54 ]. Urgency UI and overactive bladder are sometimes treated with anticholinergic drugs such as solifenacin, tolterodin or trospium (group G in the ATC classification).…”

“…However, only 6% of incontinent residents in our study took this type of drugs for the urinary tract. Therefore, our main hypothesis to explain the association with UI relates to adverse effects associated with anticholinergic activity which affect up to 87% of NH residents [ 54 ]. Anticholinergics can impair emptying and cause constipation and urinary retention [ 6 ].…”