To investigate whether the 2010 introduction of percutaneous tibial nerve stimulation and the 2013 introduction of intradetrusor onabotulinumtoxinA were associated with an increase in overall utilization of third-line treatments.
Using medical claims data from IBM Marketscan database 2010-2019, diagnosis codes were used to identify adult women with overactive bladder. Procedure codes were used to identify third-line treatments. The annual proportion of patients receiving third-line treatments was calculated, as well as the proportion of each treatment received. These were modeled as a function of treatment year using linear regression; a regression coefficient significantly different from zero was considered evidence of a significant change in utilization over time.
We identified 3,067,515 unique individuals with a diagnosis of overactive bladder, including 14,652 who initiated third-line treatments. The annual percentage of women with overactive bladder who initiated third-line treatment was 0.18% and did not change significantly over 10 years (p=0.82). However, the proportion receiving sacral neuromodulation decreased significantly (p<0.001), with a compensatory increase in intradetrusor onabotulinumtoxinA. Specifically, within 6 years of its introduction, onabotulinumtoxinA accounted for almost half of third-line treatments initiated.
Overall, third-line therapies for non-neurogenic overactive bladder are utilized infrequently among privately insured women. Over the past decade, the introduction of new treatment options has led to a shift in the type of treatment initiated, rather than to an increase in the overall utilization of third-line therapies.
Urology. 2022 Nov 24 [Epub ahead of print]
Nicholas F Scioscia, Preston Edge, Lisa R Yanek, Victoria L Handa
Resident Physician, Obstetrics and Gynecology, AHN Women's Institute, Allegheny Health Network. Electronic address: ., Department of Gynecology and Obstetrics, Johns Hopkins University School of Medicine. Electronic address: ., Department of Medicine, Johns Hopkins University School of Medicine. Electronic address: ., Department of Gynecology and Obstetrics, Johns Hopkins University School of Medicine. Electronic address: .