Overactive bladder medication prescription trends from 2014 to 2018

Abstract

Purpose A growing literature points to an association between overactive bladder (OAB) medications and dementia. Given differences in side effects for extended‐release (ER) and immediate‐release (IR) anticholinergic formulations and beta‐3 agonists, we examined prescription utilization patterns in a national dataset of older adults from 2014 to 2018. Methods We performed a retrospective study using the Medicare Part D Drug Spending Dashboard, a publicly available database that includes data from outpatient pharmacy claims from 2014 to 2018 in the United States. We identified total claims and total spending on common OAB medications, and further assessed trends by anticholinergic burden by medication, and immediate and ER formulations. Results There were 54.1 million claims for OAB medications, accounting for $10.1 billion (2018 United States dollars) in spending from 2014 to 2018. When considering beta‐agonist, mirabegron accounted for 13.1% of total claims and 29.0% of total spending. Mirabegron accounted for a greater proportion of OAB medication claims and spending during the 5 years from 5.7% to 20.1% and 11.3% to 44%, respectively. IR anticholinergics accounted for fewer total claims over this period, from 58.5% to 42.6%. ER formulations increased in proportion of all OAB medication total claims from 35.8% to 37.5% from 2014 to 2016, and decreased to 37.3% by 2018. Conclusion OAB medications and expenditures increased from 2014 to 2018. Mirabegron accounted for higher proportions and IR‐formulations for decreased proportions of each from 2014 to 2018. The impact on clinical outcomes is a key area for future investigation considering our findings.

Temporal Trends Over Two Decades in the Use of Anticholinergic Drugs Among Older Community-Dwelling People in Helsinki, Finland

“…In line with previous studies, the proportion of anticholinergic urinary antispasmodics (oxybutynin and tolterodine) decreased [12,15,21], which is a welcome and expected finding, as newer and safer drugs have emerged [25]. Interestingly, a major increase was seen in the use of antihistamines on Duran's list in ≥ 75-year-old communitydwelling people.…”

Clinical preferences and treatment attitudes among urologists, gynecologists, and geriatricians: An independent online questionnaire survey for comparison of treatment choices in the management of overactive bladder

“…Recently, Sripad et al reviewed the choice of drug preferences for prescription between 2014 and 2018 and reported an increase in mirabegron use (from 5.7% to 20.1%) for the symptomatic treatment of OAB. However, antimuscarinics still constituted a greater proportion of total prescriptions as found in the medical records 26 . In another study comparing primary care providers, UROs, OB/GYNs, and other specialties' prescription patterns for OAB showed that mirabegron preference increased during the period from 2013 to 2017, and UROs prescribed mirabegron more frequently compared to other specialties 27 …”

“…However, antimuscarinics still constituted a greater proportion of total prescriptions as found in the medical records. 26 In another study comparing primary care providers, UROs, OB/GYNs, and other specialties' prescription patterns for OAB showed that mirabegron preference increased during the period from 2013 to 2017, and UROs prescribed mirabegron more frequently compared to other specialties. 27 In the present study, the most preferred drug among antimuscarinics was solifenacin with a significantly higher rate by UROs versus OB/GYN (58.2% vs. 28.2%; p = 0.001).…”