Treatment patterns and costs among patients with OAB treated with combination oral therapy, sacral nerve stimulation, percutaneous tibial nerve stimulation, or onabotulinumtoxinA in the United States

Abstract

Introduction: Treatment patterns and costs were characterized among patients with overactive bladder (OAB) receiving later-line target therapies (combination mirabegron/antimuscarinic, sacral nerve stimulation [SNS], percutaneous tibial nerve stimulation [PTNS], or onabotulinumtoxinA). Methods: In a retrospective cohort study using 2013 to 2017 MarketScan databases, two partially overlapping cohorts of adults with OAB ("IPT cohort": patients with incident OAB pharmacotherapy use; "ITT cohort," incident target therapy) with continuous enrollment were identified; first use was index. Demographic characteristics, treatment patterns and costs over the 24-month follow-up period were summarized. Crude mean (standard deviation [SD]) OAB-specific (assessed by OAB diagnostic code or pharmaceutical dispensation record) costs were estimated according to target therapy. Results: The IPT cohort comprised 54 066 individuals (mean [SD] age 58.5 [15.0] years; 76% female), the ITT cohort, 1662 individuals (mean [SD] age 62.8 [14.9] years; 83% female). Seventeen percent of the IPT cohort were treated with subsequent line(s) of therapy after index therapy; among those, 73% received antimuscarinics, 23% mirabegron, and 1.4% a target therapy. For the ITT cohort, 32% were initially treated with SNS, 27% with onabotulinumtox-inA, 26% with combination mirabegron/antimuscarinic, and 15% with PTNS.

Efficacy and Safety of Vibegron for the Treatment of Overactive Bladder in Women: A Subgroup Analysis From the Double-Blind, Randomized, Controlled EMPOWUR Trial

“…Anticholinergics are commonly prescribed for the treatment of OAB and are more likely to be prescribed for women than for men. 6,7 However, their use is associated with persistence-limiting side effects. 1,8 Accumulating evidence suggests that long-term use of anticholinergics increases the risk of developing cognitive impairment and dementia.…”

“…Recommended second-line treatments include anticholinergics and β 3 -adrenergic receptor agonists. Anticholinergics are commonly prescribed for the treatment of OAB and are more likely to be prescribed for women than for men 6,7 . However, their use is associated with persistence-limiting side effects 1,8 .…”

Treatment patterns in women with urinary urgency and/or urgency urinary incontinence in the symptoms of Lower Urinary Tract Dysfunction Research Network Observational Cohort Study

“…Our study is the first to describe treatment patterns—escalation, de‐escalation, and continuation—that incorporates all OAB treatment modalities in a cohort of women presenting to specialty care. Kraus et al 20 described treatment patterns of patients with OAB over a 24‐month period using a large, retrospective database. They defined their cohort by identifying patients who filled an OAB medication prescription or underwent a third‐line procedure for OAB.…”

A Multi-Center, Randomized, Blind, Controlled Clinical Trial of the Safety and Efficacy of Micro Radio Frequency Therapy System for the Treatment of Overactive Bladder

“…The efficacy of pharmacotherapy is limited with low tolerance in practice ( 10 ). Surgery and neuro-modulation therapy are invasive approaches that may have to be performed in stages and have surgical realated problems ( 11 , 12 ). These limitations cause many middle-aged and elderly OAB refractory patients lack of effective treatment and seriously affect the QoL.…”