TY - JOUR
T1 - Practice patterns for women with overactive bladder syndrome
T2 - Time between medications and third-line treatments
AU - Kirby, Anna C.
AU - Park, Sungchul
AU - Cook, Sara B.
AU - Odem-Davis, Katherine
AU - Gore, John L.
AU - Wolff, Erika M.
N1 - Funding Information:
From the *Department of Obstetrics and Gynecology, University of Washington, Seattle, WA; †Department of Health Management and Policy, Drexel University, Philadelphia, PA; and ‡Department of Surgery, University of Washington; §Seattle Children’s Research Institute; and ||Department of Urology, University of Washington, Seattle, WA. This study was funded by the Department of Obstetrics and Gynecology at the University of Washington. The authors have declared they have no conflicts of interest. Correspondence: Anna C. Kirby, MD, MAS. E-mail: akirby@uw.edu. Supplemental digital contents are available for this article. Direct URL citations appear in the printed text and are provided in the HTML and PDF versions of this article on the journal’s Web site (www.fpmrs.net). Copyright © 2020 Wolters Kluwer Health, Inc. All rights reserved. DOI: 10.1097/SPV.0000000000000811
Funding Information:
The authors acknowledge the Department of Obstetrics and Gynecology at the University of Washington for funding this study.
Publisher Copyright:
© Wolters Kluwer Health, Inc. All rights reserved.
PY - 2020/7/1
Y1 - 2020/7/1
N2 - 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.
AB - 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.
KW - intradetrusor onabotulinumtoxin A
KW - overactive bladder
KW - percutaneous tibial nerve stimulation
KW - sacral neuromodulation
KW - urgency urinary incontinence
UR - http://www.scopus.com/inward/record.url?scp=85086105949&partnerID=8YFLogxK
U2 - 10.1097/SPV.0000000000000811
DO - 10.1097/SPV.0000000000000811
M3 - Article
C2 - 32265405
AN - SCOPUS:85086105949
SN - 2151-8378
VL - 26
SP - 431
EP - 436
JO - Female Pelvic Medicine and Reconstructive Surgery
JF - Female Pelvic Medicine and Reconstructive Surgery
IS - 7
ER -