AUA 2016: Initial Pharmacotherapy for Overactive Bladder Among Medicare Beneficiaries - Session Highlights

San Diego, CA USA ( Overactive bladder (OAB) affects up to half the population of older men and women, severely diminishing quality of life. By 2020, the economic costs of OAB are projected to exceed $80 billion annually, over half of which will be incurred by Medicare beneficiaries.

In effort to analyze the prescribing patterns for OAB in the Medicare population, Dr. Scales and colleagues performed a cross-sectional analysis of initial drug treatment of OAB symptoms among Medicare Part D beneficiaries. 

From 2007 to 2013, a study population of 17,944 was identified via two main criteria: (1) an outpatient encounter consistent with OAB symptoms and (2) a Medicare Part D drug claim for 1st generation (pre-2000 FDA) or 2nd generation (post-2000 FDA) pharmacotherapy. Subjects with predisposing conditions, cancer diagnoses, and prior drug treatment were excluded and the remaining cohort was controlled for comorbidity, provider specialty and demographic variation.  

Of this cohort, the average subject was aged 78 ± 7.5 years, of which 80% were female and 89% were white. 26% were dually eligible for Medicaid. Through multivariate modeling, researchers found that black beneficiaries and dual-eligibles were less likely to receive 2nd generation agents as first line therapy (black: RR 0.91, p = 0.015, Medicaid: RR: 0.95, p = 0.012).  Following, provider specialty was strongly associated with initial medication selection: urologists and gynecologists were more likely to prescribe 2nd generation drugs as compared to primary care physicians (urology: RR 1.49, p<0.001; gynecology: RR 1.30, p<0.001). 

From this data, the researchers concluded that urologic specialists were significantly more likely to use newer, more expensive agents as first line therapy for OAB. It is important to note that current guidelines do not present any substantial efficacy differences between 1st generation and 2nd generation agents. While the side effect profiles may differ, these findings may represent an opportunity to decrease prescribing costs in patients with OAB.


Presented By: Charles D. Scales, MD

Written By: by Anthony Warner; Student Research Intern, Department of Urology, University of California, Irvine at the 2016 AUA Annual Meeting - May 6 - 10, 2016 – San Diego, California, USA