National Trends in Third-Line Treatment for Overactive Bladder Among Commercially Insured Women, 2010-2019

Scioscia, Nicholas F.; Edge, Preston; Yanek, Lisa R.; Handa, Victoria L.

doi:10.1016/j.urology.2022.11.006

Cited by 7 publications

(8 citation statements)

References 21 publications

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“…7 Despite the limitations of current oral therapies, including issues with efficacy, tolerability, and cost, published studies note that only 0.18% to 7% proceed to third-line therapies. 6,7,9,13 This low rate of progression is thought in part due to limited follow-up, low referral rates to specialists, and lack of knowledge about potential treatments other than medications. 6,7,9,14 One qualitative study of patient focus groups regarding OAB care found that improved counseling regarding the natural history and treatment options for OAB would facilitate care.…”

Section: Discussionmentioning

confidence: 99%

“…For instance, in a national sample of women with OAB, the median time to medication discontinuation was 3.6 months for anticholinergic medications and 4.1 months for β3 agonists 7 . Despite the limitations of current oral therapies, including issues with efficacy, tolerability, and cost, published studies note that only 0.18% to 7% proceed to third-line therapies 6,7,9,13 . This low rate of progression is thought in part due to limited follow-up, low referral rates to specialists, and lack of knowledge about potential treatments other than medications 6,7,9,14 .…”

Section: Discussionmentioning

confidence: 99%

“…Adverse effects, limited efficacy, and insurance coverage are known barriers to accessing oral medications and contribute to poor adherence 3–5 . Despite barriers to access and poor continuation with oral medications, only 0.18% to 2.2% of patients progressed beyond behavioral therapy, physical therapy, or medication use to a third-line therapy 6,7 …”

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confidence: 99%

“…[3][4][5] Despite barriers to access and poor continuation with oral medications, only 0.18% to 2.2% of patients progressed beyond behavioral therapy, physical therapy, or medication use to a third-line therapy. 6,7 Clinical care pathways (CCP) have been shown to be an effective approach to guiding patients along a predictable treatment algorithm, which often leads to more timely treatment and can improve treatment adherence. 8,9 Although a CCP has been put forth from the Society of Urodynamics, Female Pelvic Medicine & Urogenital Reconstruction (SUFU), data on the effect of care pathway use for women with OAB are scarce.…”

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confidence: 99%

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The Impact of an Overactive Bladder Care Pathway on Longitudinal Patient Management

Selle,

Hanson,

Habermann

et al. 2024

UROGC

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Importance Implementation of an overactive bladder (OAB) care pathway may affect treatment patterns and progression. Objectives This study aimed to assess the effect of OAB care pathway implementation on treatment patterns for women with OAB. Study Design This retrospective cohort study evaluated women with OAB, before (January 1, 2015–December 31, 2017) and after (January 1, 2019–December 31, 2021) care pathway initiation. Care pathway use included standardized counseling, early introduction of therapy, and close follow-up. Primary outcomes included OAB medication use, follow-up visits, third-line therapy, and time to third-line therapy. Results A total of 1,349 women were included: 1,194 before care pathway implementation and 155 after. Patients after implementation were more likely to have diabetes mellitus (P = 0.04) and less likely to smoke (P = 0.01). Those managed via a care pathway were more likely to use any medication or third-line therapy within 1 year after consultation (61.3% vs 25.0%; P < 0.001). This included higher proportions receiving a medication (50.3% [95% confidence interval (CI), 41.8%–57.6%] vs 23.3% [95% CI, 20.9%–25.7%]; P < 0.001) and progressing to third-line therapy (22.6% [95% CI, 15.7%–28.9%] vs 2.9% [95% CI, 2%–3.9%]; P < 0.001). Among those who underwent third-line treatment, care pathway use was associated with shorter time to third-line therapy (median, 10 days [interquartile range, 1–56 days] vs 29 days [interquartile range, 7–191 days]; P = 0.013). Those managed via a care pathway were less likely to have additional clinic visits for OAB within 1 year after initial consultation (12.3% vs 23.9%; P < 0.001). Conclusions Use of an OAB care pathway was associated with higher rates of oral medication and third-line therapy yet decreased follow-up office visits. Use of an OAB care pathway may promote consistent and efficient care for women with OAB.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

mentioning

confidence: 99%

mentioning

confidence: 99%

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The Impact of an Overactive Bladder Care Pathway on Longitudinal Patient Management

Selle,

Hanson,

Habermann

et al. 2024

UROGC

View full text Add to dashboard Cite

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“…12 Other work has suggested rates of third-line utilization in the OAB population range from < 1% to 5%. 13,14 Studies have evaluated patient perceptions about third-line therapies and found that lack of access and concern about side effects negatively impacted patients' decisions to progress beyond medication therapy. 15,16 One of the challenges of OAB treatment is that symptoms often include multiple lower urinary tract symptoms.…”

mentioning

confidence: 99%

Who Progresses to Third-Line Therapies for Overactive Bladder? Trends From the AQUA Registry

Jericevic,

Shapiro,

Bowman

et al. 2024

Urology Practice

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Study Need and Importance: Overactive bladder (OAB) patients who do not reach treatment goals after second-line OAB treatments should be offered third-line therapies (percutaneous tibial nerve stimulation, sacral neuromodulation, bladder onabotulinumtoxinA). However, many patients who may be appropriate for third-line therapies may not ultimately receive them. Using the AUA Quality (AQUA) Registry, we evaluated factors that impact progression from second-to third-line OAB therapy, median time for progression to third-line therapy, and third-line therapy utilization across patient subgroups. What We Found: Only 2.9% of OAB patients progressed to third-line therapies over the 7-year study period. Women, White race, age 65 to 79, prior dual anticholinergic and b3 agonist therapy, government insurance, metropolitan setting, and single specialty practice were associated with the greatest odds of treatment with third-line therapy. Time to progression from second-to third-line therapies was > 1 year. Patients < 50 years and women progressed fastest through the OAB pathway. Black and Asian race, male gender, and rural setting all had lower odds of progressing to third-line therapy. Bladder onabotulinumtoxinA was the most common initial third-line therapy overall (40%), followed by sacral neuromodulation (32%) and percutaneous tibial nerve stimulation (28%). The Figure demonstrates the choice of initial third-line therapy across subgroups. Limitations: The AQUA Registry does not provide information on OAB severity or capture any patient-reported UROLOGY PRACTICE Ò Ó 2024 by AMERICAN UROLOGICAL ASSOCIATION EDUCATION AND RESEARCH, INC.

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Trends in Overactive Bladder Therapy: Associations Between Clinical Care Pathways, Practice Guidelines, and Therapy Utilization Patterns

Mohamud,

Sinclair,

Gunamany

et al. 2024

Neurourology and Urodynamics

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IntroductionOveractive bladder (OAB) is a chronic condition with significant financial and health‐related consequences. Guidelines and treatment pathways were created to optimize care and provide a clinical framework for diagnosing and managing OAB. However, the impact of these efforts and patterns of medical treatment for OAB are poorly understood. Therefore, we sought to evaluate overall trends in therapy utilization before and after the 2014 American Urological Association (AUA)/Society of Urodynamics, Female Pelvic Medicine and Urogenital Reconstruction (SUFU) OAB guideline amendment and publication of the OAB clinical care pathway in 2016.MethodsIn this retrospective cohort study, we analyzed data from Optum, a national administrative health and pharmacy claims database, between 2013 and 2018. All adult patients diagnosed with idiopathic OAB were identified by the International Classification of Diseases 9th and 10th Revision codes. Oral OAB therapies were identified using National Drug Codes, while third‐line therapy procedures, onabotulinumtoxinA (BTX), sacral neuromodulation (SNM), and percutaneous tibial nerve stimulation (PTNS), were identified using Current Procedural Terminology (CPT) codes. The study's primary outcome was the annual number of OAB prescriptions filled by pharmacotherapy class and the number of minimally invasive therapies performed during the study period. The secondary outcome was the association between OAB therapy utilization and various clinical and sociodemographic factors. Patterns of care were analyzed from 2013 to 2018, and initial treatment with each therapy was collected, excluding repeat procedures from the analysis.Results1 825 782 patients were included in the study. The mean age was 61.1 ± 16.7 years, and 1 071 420 patients were female (58.7%). The number of new OAB diagnoses increased by 369% from 2013 to 2017. During the 6‐year study period, 347 052 (19%) patients were treated with oral and/or third‐line therapies. The overall number of oral medications prescribed peaked in 2016, followed by a 17% decline between 2016 and 2018. In 2013, the two most prescribed oral medications were oxybutynin (46%) and solifenacin (31.8%). By 2018, mirabegron (18.5%) surpassed solifenacin (16.5%), with oxybutynin still accounting for most prescriptions written (55%). Eighty percent of all initial mirabegron prescriptions were filled by patients over the age of 65. The rate of third‐line therapy procedures almost doubled between 2013 and 2018 (9–17 procedures per 1000 OAB patients, p < 0.001).ConclusionsFollowing the publication of the first OAB guidelines, there was an increase in OAB diagnoses, followed by a decrease in anticholinergic medication use, and a rise in beta‐3 agonist utilization in patients over 65 years old. Additionally, there was greater adoption of third‐line OAB therapies. These trends indicate that OAB therapy guidelines and clinical practice pathways may influence treatment patterns. Given the recent publication of the OAB guidelines, further studies are necessary to assess their impact on therapy utilization patterns.

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National Trends in Third-Line Treatment for Overactive Bladder Among Commercially Insured Women, 2010-2019

Cited by 7 publications

References 21 publications

The Impact of an Overactive Bladder Care Pathway on Longitudinal Patient Management

The Impact of an Overactive Bladder Care Pathway on Longitudinal Patient Management

Who Progresses to Third-Line Therapies for Overactive Bladder? Trends From the AQUA Registry

Trends in Overactive Bladder Therapy: Associations Between Clinical Care Pathways, Practice Guidelines, and Therapy Utilization Patterns

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