Advertisement

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

  • Author Footnotes
    ⁎ Preston Edge M.D. and Nicholas Scioscia D.O. contributed equally to this paper
    Nicholas F. Scioscia
    Footnotes
    ⁎ Preston Edge M.D. and Nicholas Scioscia D.O. contributed equally to this paper
    Affiliations
    Resident Physician, Obstetrics and Gynecology, AHN Women's Institute, Allegheny Health Network
    Search for articles by this author
  • Author Footnotes
    ⁎ Preston Edge M.D. and Nicholas Scioscia D.O. contributed equally to this paper
    Preston Edge
    Correspondence
    Corresponding Author: Preston Edge, M.D., Department of Gynecology and Obstetrics, Johns Hopkins University School of Medicine, Phone: 812-319-9954
    Footnotes
    ⁎ Preston Edge M.D. and Nicholas Scioscia D.O. contributed equally to this paper
    Affiliations
    Department of Gynecology and Obstetrics, Johns Hopkins University School of Medicine
    Search for articles by this author
  • Lisa R. Yanek
    Affiliations
    Department of Medicine, Johns Hopkins University School of Medicine
    Search for articles by this author
  • Victoria L. Handa
    Affiliations
    Department of Gynecology and Obstetrics, Johns Hopkins University School of Medicine
    Search for articles by this author
  • Author Footnotes
    ⁎ Preston Edge M.D. and Nicholas Scioscia D.O. contributed equally to this paper
Published:November 23, 2022DOI:https://doi.org/10.1016/j.urology.2022.11.006

      Abstract

      Objectives

      To investigate whether the 2010 introduction of percutaneous tibial nerve stimulation and the 2013 introduction of intradetrusor onabotulinumtoxinA were associated with an increase in overall utilization of third-line treatments.

      Methods

      Using medical claims data from IBM Marketscan database 2010-2019, diagnosis codes were used to identify adult women with overactive bladder. Procedure codes were used to identify third-line treatments. The annual proportion of patients receiving third-line treatments was calculated, as well as the proportion of each treatment received. These were modeled as a function of treatment year using linear regression; a regression coefficient significantly different from zero was considered evidence of a significant change in utilization over time.

      Results

      We identified 3,067,515 unique individuals with a diagnosis of overactive bladder, including 14,652 who initiated third-line treatments. The annual percentage of women with overactive bladder who initiated third-line treatment was 0.18% and did not change significantly over 10 years (p=0.82). However, the proportion receiving sacral neuromodulation decreased significantly (p<0.001), with a compensatory increase in intradetrusor onabotulinumtoxinA. Specifically, within 6 years of its introduction, onabotulinumtoxinA accounted for almost half of third-line treatments initiated.

      Conclusions

      Overall, third-line therapies for non-neurogenic overactive bladder are utilized infrequently among privately insured women. Over the past decade, the introduction of new treatment options has led to a shift in the type of treatment initiated, rather than to an increase in the overall utilization of third-line therapies.

      Keywords

      Abbreviations:

      AUA (American Urologic Association), BTX (intradetrusor chemodenervation with onabotulinum toxin A), CCAE (Commercial Claims and Encounters), CPT (Current Procedural Terminology), FDA (Food and Drug Administration), ICD (International Classification of Disease), IRB (Institutional Review Board), OAB (overactive bladder), PTNS (percutaneous tibial nerve stimulation), SNM (sacral neuromodulation), SUFU (society of urodynamics, female pelvic medicine & urogenital reconstruction)
      To read this article in full you will need to make a payment

      Purchase one-time access:

      Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online access
      One-time access price info
      • For academic or personal research use, select 'Academic and Personal'
      • For corporate R&D use, select 'Corporate R&D Professionals'

      Subscribe:

      Subscribe to Urology
      Already a print subscriber? Claim online access
      Already an online subscriber? Sign in
      Institutional Access: Sign in to ScienceDirect

      References

        • Haylen BT
        • de Ridder D
        • Freeman RM
        • et al.
        An International Urogynecological Association (IUGA)/International Continence Society (ICS) joint report on the terminology for female pelvic floor dysfunction.
        Neurourol Urodyn. 2010; 29: 4https://doi.org/10.1002/nau.20798
        • Hartmann KE
        • McPheeters ML
        • Biller DH
        • et al.
        Treatment of overactive bladder in women.
        Evid Rep Technol Assess (Full Rep). 2009; 187: 94
        • Lightner DJ
        • Gomelsky A
        • Souter L
        • et al.
        Diagnosis and Treatment of Overactive Bladder (Non-Neurogenic) in Adults: AUA/SUFU Guideline Amendment 2019.
        J Urol. 2019; 202: 558https://doi.org/10.1097/JU.0000000000000309
        • Reynolds WS
        • McPheeters M
        • Blume J
        • et al.
        Comparative Effectiveness of Anticholinergic Therapy for Overactive Bladder in Women.
        Obstet Gynecol. 2015; 125: 1423https://doi.org/10.1097/AOG.0000000000000851
        • Sheyn D
        • Ju M
        • Zhang S
        • et al.
        Development and Validation of a Machine Learning Algorithm for Predicting Response to Anticholinergic Medications for Overactive Bladder Syndrome.
        Obstet Gynecol. 2019; 134: 946https://doi.org/10.1097/AOG.0000000000003517
      1. Premarket Approval Database: Interstim. Food and Drug Administration Web Site. https://www.accessdata.fda.gov/scripts/cdrh/cfdocs/cfpma/pma.cfm?id=P970004. Accessed October 8, 2021.

      2. 510(k) Premarket Notification Database: NURO Neuromodulation System. Food and Drug Administration Web Site. https://www.accessdata.fda.gov/cdrh_docs/pdf10/K101847.pdf. Accessed October 8, 2021.

        • Schurch B
        • Schmid DM
        • Stöhrer M
        Treatment of neurogenic incontinence with botulinum toxin A.
        N Engl J Med. 2000; 342: 665https://doi.org/10.1056/NEJM200003023420918
      3. Drug Databases: FDA-Approved Drugs: BOTOX. Food and Drug Administration Web Site. https://www.accessdata.fda.gov/scripts/cder/daf/index.cfm?event=overview.process&ApplNo=103000. Accessed October 8, 2021.

      4. Butler AM, Nickel KB, Overman RA, et al: IBM MarketScan Research databases. In Databases for Pharmacoepidemiological Research. Sturkenboom M and Schink T. Springer, Cham 2021; 1: 243–251.

      5. Watson Health IBM Corporation 2021. IBM MarketScan Research Databases for Life Sciences Researchers. https://www.ibm.com/products/marketscan-research-databases/databases. Accessed April 20, 2022.

        • Chughtai B
        • Clemens JQ
        • Thomas D
        • et al.
        Real World Performance of Sacral Neuromodulation and OnabotulinumtoxinA for Overactive Bladder: Focus on Safety and Cost.
        J Urol. 2020; 203: 179https://doi.org/10.1097/JU.0000000000000462
        • Linder BJ
        • Gebhart JB
        • Elliott DS
        • et al.
        National Patterns of Filled Prescriptions and Third-Line Treatment Utilization for Privately Insured Women With Overactive Bladder.
        Female Pelvic Med Reconstr Surg. 2021; 27: e261https://doi.org/10.1097/SPV.0000000000000744
        • Anger JT
        • Goldman HB
        • Luo X
        • et al.
        Patterns of medical management of overactive bladder (OAB) and benign prostatic hyperplasia (BPH) in the United States.
        Neurourol Urodyn. 2018; 37: 213https://doi.org/10.1002/nau.23276
      6. Glossary. United States Census Bureau Web Site. https://www.census.gov/programs-surveys/metro-micro/about/glossary.html. Accessed August 11, 2022.

        • Davidson ER
        • Miceli L
        • Propst K.
        Why Patients Fall Through the Cracks: Assessment of Patients' Overactive Bladder Treatment.
        J Womens Health (Larchmt). 2022; 31: 1314https://doi.org/10.1089/jwh.2021.0635
        • Lee UJ
        • Feinstein L
        • Ward JB
        • et al.
        National Trends in the Surgical Management of Urinary Incontinence among Insured Women, 2004 to 2013: The Urologic Diseases in America Project.
        J Urol. 2020; 203: 365https://doi.org/10.1097/JU.0000000000000569
        • Laudano MA
        • Seklehner S
        • Sandhu J
        • et al.
        Disparities in the use of sacral neuromodulation among Medicare beneficiaries.
        J Urol. 2015; 194: 449https://doi.org/10.1016/j.juro.2015.03.111
        • Jiang J
        • Patil D
        • Traore EJ
        • et al.
        Contemporary Patterns of Third-line Treatments for Privately Insured Individuals With Overactive Bladder in the United States.
        Urology. 2020; 142: 87https://doi.org/10.1016/j.urology.2020.04.102
        • Chen Z
        • Roy K
        • Khushalani JS
        • et al.
        Trend in rural-urban disparities in access to outpatient mental health services among US adults aged 18-64 with employer-sponsored insurance: 2005-2018.
        J Rural Health. 2022; 38: 788https://doi.org/10.1111/jrh.12644
        • Graves JM
        • Mackelprang JL
        • Moore M
        • et al.
        Rural-urban disparities in health care costs and health service utilization following pediatric mild traumatic brain injury.
        Health Serv Res. 2019; 54: 337https://doi.org/10.1111/1475-6773.13096
        • Gonzalez DC
        • Khorsandi S
        • Mathew M
        • et al.
        A systematic review of racial/ethnic disparities in female pelvic floor disorders.
        Urology. 2022; 163: 8https://doi.org/10.1016/j.urology.2021.09.018
        • Tellechea L
        • Zuo S
        • Kohn JR
        • et al.
        The effect of social determinants of health on overactive bladder symptom severity.
        J Urol. 2021; 205: 1415https://doi.org/10.1097/JU.0000000000001545
        • McCrery R
        • Lane F
        • Benson K
        • et al.
        Treatment of Urinary Urgency Incontinence Using a Rechargeable SNM System: 6-Month Results of the ARTISAN-SNM Study.
        J Urol. 2020; 203: 185https://doi.org/10.1097/JU.0000000000000458
        • MacDiarmid S
        • Staskin DR
        • Lucente V
        • et al.
        Feasibility of a Fully Implanted, Nickel Sized and Shaped Tibial Nerve Stimulator for the Treatment of Overactive Bladder Syndrome with Urgency Urinary Incontinence.
        J Urol. 2019; 201: 967https://doi.org/10.1016/j.juro.2018.10.017
        • Gray SL
        • Anderson ML
        • Dublin S
        • et al.
        Cumulative use of strong anticholinergics and incident dementia: a prospective cohort study.
        JAMA Intern Med. 2015; 175: 401https://doi.org/10.1001/jamainternmed.2014.7663
        • Risacher SL
        • McDonald BC
        • Tallman EF
        • et al.
        Alzheimer's Disease Neuroimaging Initiative. Association Between Anticholinergic Medication Use and Cognition, Brain Metabolism, and Brain Atrophy in Cognitively Normal Older Adults.
        JAMA Neurol. 2016; 73: 721https://doi.org/10.1001/jamaneurol.2016.0580