Treatment patterns and costs among patients with OAB treated with combination oral therapy, sacral nerve stimulation, percutaneous tibial nerve stimulation, or onabotulinumtoxinA in the United States

Stephen R Kraus, Aki Shiozawa, Shelagh M Szabo, Christina Qian, Basia Rogula, John Hairston, Stephen R Kraus, Aki Shiozawa, Shelagh M Szabo, Christina Qian, Basia Rogula, John Hairston

Abstract

Introduction: Treatment patterns and costs were characterized among patients with overactive bladder (OAB) receiving later-line target therapies (combination mirabegron/antimuscarinic, sacral nerve stimulation [SNS], percutaneous tibial nerve stimulation [PTNS], or onabotulinumtoxinA).

Methods: In a retrospective cohort study using 2013 to 2017 MarketScan databases, two partially overlapping cohorts of adults with OAB ("IPT cohort": patients with incident OAB pharmacotherapy use; "ITT cohort," incident target therapy) with continuous enrollment were identified; first use was index. Demographic characteristics, treatment patterns and costs over the 24-month follow-up period were summarized. Crude mean (standard deviation [SD]) OAB-specific (assessed by OAB diagnostic code or pharmaceutical dispensation record) costs were estimated according to target therapy.

Results: The IPT cohort comprised 54 066 individuals (mean [SD] age 58.5 [15.0] years; 76% female), the ITT cohort, 1662 individuals (mean [SD] age 62.8 [14.9] years; 83% female). Seventeen percent of the IPT cohort were treated with subsequent line(s) of therapy after index therapy; among those, 73% received antimuscarinics, 23% mirabegron, and 1.4% a target therapy. For the ITT cohort, 32% were initially treated with SNS, 27% with onabotulinumtoxinA, 26% with combination mirabegron/antimuscarinic, and 15% with PTNS. Subsequently, one-third of this cohort received additional therapies. Mean (SD) costs were lowest among patients receiving index therapy PTNS ($6959 [$7533]) and highest for SNS ($29 702 [$26 802]).

Conclusions: Costs for SNS over 24 months are substantially higher than other treatments. A treatment patterns analysis indicates that oral therapies predominate; first-line combination therapy is common in the ITT cohort and uptake of oral therapy after procedural options is substantial.

Keywords: combination mirabegron/antimuscarinic therapy; costs and resource utilization; onabotulinumtoxinA; overactive bladder; percutaneous tibial nerve stimulation; sacral nerve stimulation.

© 2020 The Authors. Neurourology and Urodynamics published by Wiley Periodicals LLC.

Figures

Figure 1
Figure 1
Study design schematic.1A confirmatory refill within 30 days of both mirabegron and any antimuscarinic were required to verify that the first observed instance was a combination therapy (and not a treatment switch). If the antimuscarinic continues after discontinuation of mirabegron (or vice versa), this is considered a de‐escalation and new line of therapy. 2Simultaneous codes of revision or removal of peripheral neurostimulator electrode array and pulse generator or receiver OR one of these revision/removal codes with no follow‐up maintenance code for more than 6 months were considered sacral nerve stimulation discontinuation
Figure 2
Figure 2
Sankey diagram of treatment pathways in the IPT and ITT cohorts. IPT, incident pharmacotherapy; ITT, incident target therapy; LOT, line of therapy; PTNS, percutaneous tibial nerve stimulation; SNS, sacral nerve stimulation

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