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Yearly Trends of Overactive Bladder Medication Usage.

Kevin J Chua1, Hiren V Patel1, Alexandra Tabakin1

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Oxybutynin remains the most prescribed overactive bladder (OAB) medication, while mirabegron use has significantly increased. Less cognitively impactful anticholinergics are prescribed least often.

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Area of Science:

  • Urology
  • Pharmacology
  • Geriatrics

Background:

  • Anticholinergic medications for overactive bladder (OAB) are linked to cognitive side effects and dementia.
  • Agents like trospium, fesoterodine, and darifenacin show reduced blood-brain barrier penetration.
  • Mirabegron, a beta-3 adrenoreceptor agonist, was approved for OAB in 2012.

Purpose of the Study:

  • To analyze trends in the prescription patterns of overactive bladder (OAB) medications in the United States.
  • To compare the utilization of different OAB drug classes over a five-year period.

Main Methods:

  • Utilized the 2013-2017 Medicare Part D Public Use File to identify OAB medication prescribers.
  • Analyzed prescription claims and total annual expenditures for oxybutynin, tolterodine, trospium, darifenacin, solifenacin, fesoterodine, and mirabegron.
  • Segmented data by all prescribers, non-urologists, and urologists.

Main Results:

  • Oxybutynin was the most prescribed OAB medication, accounting for 53.9% of prescriptions in 2017.
  • Mirabegron prescriptions surged from 140,401 in 2013 to 1,617,439 in 2017, becoming the second most prescribed.
  • Solifenacin prescriptions declined annually, while trospium, darifenacin, and fesoterodine remained the least prescribed.
  • Mirabegron incurred the highest total expenditure ($658.6 million in 2017).

Conclusions:

  • Oxybutynin consistently led OAB medication prescriptions throughout the study period.
  • Mirabegron utilization demonstrated a significant and steady year-over-year increase.
  • Anticholinergic drugs with lower cognitive side effect risks were the least utilized OAB treatments.