SUFU 2020: Treatment Patterns and Costs Among Patients with Overactive Bladder Receiving Combination Oral Therapy, Sacral Nerve Stimulation, Percutaneous Tibial Nerve Stimulation or OnabotulinumtoxinA

Scottsdale, AZ ( Dr. Stephen Kraus, and his team reviewed the characterize treatment patterns and costs among patients with overactive bladder (OAB) on target therapies (combination mirabegron/antimuscarinic, sacral nerve stimulation (SNS), percutaneous tibial nerve stimulation (PTNS) or onabotulinumtoxinA) in the United States. Patients whose OAB symptoms are inadequately addressed with monotherapy may seek alternative treatments including SNS, PTNS, or onabotulinumtoxinA injection.  As these options are relatively invasive, combination mirabegron/antimuscarinic oral therapy has been investigated in trials with favorable results.

This was retrospective cohort study was performed using the 2013-2017 MarketScan databases. Two cohorts of adult patients with OAB were identified; the first cohort with incident use of pharmacotherapy and a second cohort with incident use of a target therapy (with no target therapy 12-months prior). The date of first use was defined as the index date. Both cohorts were limited to those with 12 months of pre-index and 24 months of post-index continuous enrolment. Demographic characteristics and treatment patterns over the 24-month follow-up period were summarized. Crude mean (standard deviation [SD]) all-cause (all inpatient, outpatient and pharmaceutical records) and OAB-specific (inpatient or outpatient records with an OAB diagnostic code attached or pharmaceutical records for OAB-specific dispensations) costs were estimated according to target therapy from treatment initiation until end of follow-up.

There was a 54,066 patients has incident pharmacotherapy for OAB over a one-year period, 54,066 patients had incident pharmacotherapy for OAB (mean [SD] age 58.5 [15.0] years;76% female),and 1,662 patients had incident target therapy for OAB (mean [SD] age 62.8 [14.9] years;83% female). Over 24 months,1.4% of the incident pharmacotherapy cohort were treated with a target therapy. Seventeen percent were treated with at least one subsequent line of therapy; switching between antimuscarinics was common (73% had antimuscarinics as second line). Among the incident target therapy cohort, 32% were initially treated with SNS, 27% with onabotulinumtoxinA, 26% with combination mirabegron/antimuscarinic therapy and 15% with PTNS; approximately one-third of these patients received additional lines of therapy.

Efficacious treatments are needed for patients whose OAB symptoms are not responding to monotherapy. Observed treatment patterns show substantial turnover in therapy after initial pharmacotherapy. As procedural therapies are invasive and can be costly, combination mirabegron/antimuscarinic therapy may offer an alternative.

Presented by: Stephen Kraus, MD, FACS1

Co-Authors: Aki Shiozawa, DrPH2, Shelagh Szabo, MSc3, Christina Qian, MSc3, Basia Rogula, MSc3, John Hairston, MD2

1. University of Texas Health Sciences Center, San Antonio, Texas
2. Astellas Pharma Global Development, Inc, Northbrook, Illinois 
3. Broadstreet HEOR, Vancouver, BC, Canada

Written by: Bilal Farhan, MD, Assistant Professor, Division of Urology, University of Texas, Medical Branch, Texas; @BilalfarhanMD at the Society of Urodynamics, Female Pelvic Medicine & Urogenital Reconstruction Winter Meeting, SUFU 2020, February 25 - February 29, 2020, Scottsdale, Arizona