Determining a Real-world Definition of Percutaneous Tibial Nerve Stimulation Induction Therapy in Medicare...

To examine real-world utilization of induction percutaneous tibial nerve stimulation (PTNS) among Medicare beneficiaries to determine a more realistic, population-specific definition of induction PTNS in older adults, given poor overall adherence with the standard induction PTNS schedule.

This is a retrospective cohort study of a 100% sample of fee-for-service Medicare beneficiaries undergoing PTNS treatment for idiopathic OAB from 2015 to 2020. Histograms and sensitivity analyses were explored to yield an optimal definition of induction PTNS based on real-world utilization. An adjusted multivariable modified Poisson regression was then created to determine factors associated with completing this cohort-based definition.

A total of 41,962 beneficiaries underwent induction PTNS. The histogram's mode and 75th percentile and sensitivity analyses yielded an induction PTNS schedule of 11 treatments in 15 weeks, completed by 32.6% of beneficiaries, compared to 7.9% completing the standard schedule. Beneficiaries who were older (≥85 years, aRR 0.92 vs 66-74 years), non-white race (aRR 0.90), more comorbid (CCI ≥4, aRR 0.80 vs CCI of 0), and more frail (aRR 0.93 vs not frail) were less likely to complete the cohort-based definition.

This study determined a new definition for induction PTNS (11 sessions in 15 weeks), completed by 3 times as many beneficiaries as the standard schedule. These findings support a more realistic definition that can be used for future research on PTNS utilization in this population.