SUFU 2022: Trends in Overactive Bladder Therapy Utilization: An Evaluation of the Impact of Clinical Care Pathways and Practice Guidelines

( Evidence-based treatments are available for overactive bladder (OAB) with published guidelines and treatment pathways created for clinicians to optimize treatment and provide a clinical framework for diagnosis and treatment. The impact of these efforts remains unclear and medical treatment pathways are poorly understood. This study evaluated overall trends in therapy utilization before and after the 2014 AUA/SUFU OAB guideline amendment and publication of the OAB clinical care pathway in 2016.

This study analyzed data from Optum, a national administrative health and pharmacy claims database between 2013-2018 by identifying adult patients with a diagnosis of non-neurogenic OAB (used ICD 9 & 10). Oral drug therapies were identified using National Drug Codes. 3rd line treatments (onabotulinumtoxinA (BTX), sacral neuromodulation (SNM), percutaneous tibial nerve stimulation (PTNS) were identified using CPT codes and patterns of care. Initial treatment with each therapy was collected. Repeat procedures were excluded from the analysis.

Oral and/or advanced therapies were prescribed in 19% of patients with advanced therapy procedures almost doubling between 2013 and 2018 (9 to 17 procedures per 1,000 OAB patients, p for trend <0.001). The most significant rise was noted between 2016 and 2018, during which time BTX surpassed SNM and PTNS. The overall number of oral medications prescribed peaked in 2016 after which there has been a 17% decline between 2016 and 2018. The two most commonly prescribed oral medications in 2013 were oxybutynin (46%) and solifenacin (31.75%) with mirabegron (18.5%) surpassing solifenacin (16.5%) in 2018 and Oxybutynin accounting for 55% of prescriptions written.

The analysis showed that rates of third line therapy utilization increased significantly in the two years following the release of the 2016 OAB clinical care pathway. This may suggest that guidelines and clinical care pathways may have influenced the trends in therapy utilization. The authors felt that another reason for this increase in 3rd line treatment and a slight decrease in medication prescribing may be also due in part to increasing concern over associations with anticholinergic medications and dementia.

Presented by: Claire S. Burton,1 Amy Zhang,1 Alayne Markland,2 Ekene Enemchukwu1

  1. Stanford University
  2. University of Alabama at Birmingham

Written by: Diane K. Newman, DNP, ANP-BC, FAAN, Adjunct Professor of Urology in Surgery, Perelman School of Medicine, University of Pennsylvania and Co-Director of the Penn Center for Continence and Pelvic Health at the 2022 Society of Urodynamics, Female Pelvic Medicine & Urogenital Reconstruction (SUFU) Winter Meeting, February 22 - 26, 2022