Chemodenervation Use for Overactive Bladder in Female Medicare Beneficiaries

Only a fraction of women with overactive bladder (OAB) receive effective treatment for this condition; inequities in access to OAB care must be understood.

The objective of this study was to explore features associated with intradetrusor chemodenervation treatment for OAB among female Medicare beneficiaries from different racial and ethnic groups.

This was a retrospective cohort study of females ≥65 years old from the Center for Medicare & Medicaid Services' 5% Limited Data Set with a diagnosis of OAB between 2012 and 2020. The cumulative incidence of beneficiaries who received intradetrusor chemodenervation within 5 years following OAB diagnosis was compared between race and ethnicity groups. Cox regression analysis was performed to determine predictors for the likelihood of intradetrusor chemodenervation treatment and to adjust for potential confounders.

In total, 232,366 females with a new OAB diagnosis were identified. The cumulative incidence of intradetrusor chemodenervation treatment within 5 years of OAB diagnosis was low at 1.4%, with lower rates among Asian (0.6%), Black (0.7%), Hispanic (0.7%), and Other groups (0.9%) ( P < 0.001). After adjustments, non-White race and Hispanic ethnicity (Asian: adjusted hazard ratio [aHR] 0.51, 95% CI: 0.33-0.80; Black: aHR 0.56, 95% CI: 0.45-0.69; Hispanic: aHR 0.62, 95% CI: 0.40-0.96; Other: aHR 0.58, 95% CI: 0.37-0.91) were associated with a lower relative hazard of receiving intradetrusor chemodenervation.

Overall utilization of intradetrusor chemodenervation was low in this national cohort. Women from non-White racial and ethnic groups had lower rates of utilization compared with White women. Further research should evaluate barriers patients face in accessing this effective OAB treatment and explore potential interventions that facilitate access to care.