Racial and Socioeconomic Factors Influence Utilization of Advanced Therapies in Commercially Insured OAB Patients: An Analysis of over 800,000 OAB Patients.

To determine if racial and/or socioeconomic factors influence advanced therapy utilization for refractory overactive bladder (OAB) amongst the commercially insured.

We queried Optum®, a national claims database, between 2003-2017.

Non-neurogenic OAB patients were identified using ICD-9/10 diagnosis codes. Demographic and treatment data were collected, including oral medication therapies (anticholinergic, beta3 agonists), and advanced therapies (OnabotulinumtoxinA (BTX), Sacral Nerve Stimulation (SNS), percutaneous tibial nerve stimulation (PTNS)). Associations between patient sociodemographic factors and advanced therapy utilization were explored.

Of 4,229,617 OAB patients, 807,612 (19%) received medical therapies, of which 95% received oral medications only and 4.7% received advanced therapies. Asians had the lowest use of oral therapies (14% versus 18-19% in other races/ethnicities, p<0.05), and advanced therapies (0.44% vs 0.71-0.93%, p<0.05). Asians and Hispanics were least likely to utilize SNS therapy and most likely to use PTNS compared to Blacks and Whites. BTX use was similar between races/ethnicities (p<0.05). Female gender (OR 1.65 [CI 1.61,1.69]), younger age (<65) (OR 1.28 [1.25,1.31]), higher annual income ≥$40K (OR 1.09 [1.06,1.12]) and prior use of oral medications (OR 3.30 [3.21,3.38] for 1 medication) were significantly associated with receiving advanced therapies. Nonwhite race (OR 0.89 [0.87,0.91]), lower education level (less than a bachelor's degree) (OR 0.97 [0.94,0.99]), and Northeast region were associated with a lower likelihood of receiving advanced therapies (p<0.05 for all).

Amongst commercially insured, racial and socioeconomic factors predict utilization of advanced OAB therapies, including race/ethnicity, age, gender, education level, and region.

Urology. 2020 May 18 [Epub ahead of print]

Raveen Syan, Chiyuan A Zhang, Ekene A Enemchukwu

Department of Urology, University of Miami, Miami, FL. Electronic address: ., Department of Urology, University of Miami, Miami, FL., Department of Urology, University of Miami, Miami, FL; Department of Urology, Stanford University, Stanford, CA.

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