Trends in Overactive Bladder Therapy: Associations Between Clinical Care Pathways, Practice Guidelines, and Therapy...

Area of Science:

• Urology
• Pharmacology
• Health Services Research

Background:

• Overactive bladder (OAB) is a prevalent chronic condition with substantial health and economic burdens.
• Clinical guidelines and care pathways aim to standardize OAB diagnosis and management.
• Understanding OAB treatment trends is crucial for optimizing patient care.

Purpose of the Study:

• To evaluate trends in OAB therapy utilization before and after the 2014 AUA/SUFU guideline amendment and 2016 clinical care pathway publication.
• To analyze changes in oral pharmacotherapy and third-line procedural therapy use.
• To identify associations between OAB treatment patterns and patient demographics.

Main Methods:

• Retrospective cohort study using a national administrative claims database (2013-2018).
• Identified adult patients with idiopathic OAB using ICD codes.
• Analyzed oral OAB medications (NDC codes) and third-line therapies (onabotulinumtoxinA, SNM, PTNS) using CPT codes.

Main Results:

• Over 1.8 million patients were included; new OAB diagnoses surged by 369% (2013-2017).
• Oral medication prescriptions peaked in 2016, declining 17% by 2018; mirabegron use increased, particularly in patients over 65.
• Third-line therapy procedures nearly doubled between 2013 and 2018.

Conclusions:

• OAB guidelines appear to influence treatment patterns, with increased diagnoses and shifts in medication use.
• A decrease in anticholinergic use and a rise in beta-3 agonist utilization were observed, especially in older adults.
• Increased adoption of third-line therapies suggests guideline impact, warranting further investigation.