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Health Resource Utilization and Cost for Patients with Incontinent Overactive Bladder Treated with Anticholinergics

BACKGROUND: Overactive bladder (OAB) is a common medical condition with significant economic and humanistic burden. Inadequately managed OAB may exacerbate or result in comorbidities such as depression, falls, and urinary tract infections, which can further increase the burden to the health care sys...

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Autores principales: Yehoshua, Alon, Chancellor, Michael, Vasavada, Sandip, Malone, Daniel C., Armstrong, Edward P., Joshi, Manher, Campbell, Karen, Pulicharam, Riya
Formato: Online Artículo Texto
Lenguaje:English
Publicado: Academy of Managed Care Pharmacy 2016
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10397717/
https://www.ncbi.nlm.nih.gov/pubmed/27023694
http://dx.doi.org/10.18553/jmcp.2016.22.4.406
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author Yehoshua, Alon
Chancellor, Michael
Vasavada, Sandip
Malone, Daniel C.
Armstrong, Edward P.
Joshi, Manher
Campbell, Karen
Pulicharam, Riya
author_facet Yehoshua, Alon
Chancellor, Michael
Vasavada, Sandip
Malone, Daniel C.
Armstrong, Edward P.
Joshi, Manher
Campbell, Karen
Pulicharam, Riya
author_sort Yehoshua, Alon
collection PubMed
description BACKGROUND: Overactive bladder (OAB) is a common medical condition with significant economic and humanistic burden. Inadequately managed OAB may exacerbate or result in comorbidities such as depression, falls, and urinary tract infections, which can further increase the burden to the health care system. Anticholinergics are often prescribed for management of OAB with urinary incontinence (“wet” OAB). However, research has shown that patient adherence and persistence to anticholinergic therapy is poor, with approximately 80% of patients ultimately failing their first prescribed anticholinergic medication within the first year. While there has been a fair amount of research on the economic burden of OAB, the real-world impact of initiating anticholinergic therapy in patients with wet OAB has not been well studied. OBJECTIVE: To compare falls/fractures, anxiety/depression, health care resource utilization, and health care costs between a cohort of patients with wet OAB who initiated anticholinergic therapy and a matched cohort of patients without OAB. METHODS: This study was a retrospective medical and pharmacy claims analysis. Cases were members of a primary care-based, multispecialty physician medical group located in California. Cases were eligible for inclusion if they were prescribed anticholinergic therapy between January 2008 and May 2012 based on pharmacy claims, had a diagnosis of OAB, and reported having ≥ 1 urinary incontinence episode per day. Wet OAB cases were matched to non-OAB controls in a 1:3 ratio based on sex, age, and observation time. Medical and pharmacy claims data were used to analyze patient comorbidities, as well as track health care resource utilization (HRU) and direct payer costs. RESULTS: After initiating anticholinergic therapy, wet OAB patients had a 46% higher adjusted risk of experiencing falls/fractures (P < 0.001) and a 33% higher adjusted risk of experiencing depression/anxiety (P = 0.022) than non-OAB patients. Wet OAB was significantly associated with increased HRU rates of hospital admissions, outpatient visits, prescriptions filled, and diagnostic tests performed. After adjustment for covariates, total health care cost was 33% higher for wet OAB patients than non-OAB patients, resulting in an increased cost of $1,746 per member per year. CONCLUSIONS: The findings of this research suggest OAB patients who initiate anticholinergic therapy and still experience incontinence are at a greater risk for comorbidities such as falls/fractures and depression/anxiety, and use significantly more health care resources, than patients without OAB. Programs to improve patient monitoring and referrals, the appropriate use of alternative treatments within guidelines, and adherence to evidence-based practice parameters may improve clinical outcomes and decrease HRU for these patients.
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spelling pubmed-103977172023-08-04 Health Resource Utilization and Cost for Patients with Incontinent Overactive Bladder Treated with Anticholinergics Yehoshua, Alon Chancellor, Michael Vasavada, Sandip Malone, Daniel C. Armstrong, Edward P. Joshi, Manher Campbell, Karen Pulicharam, Riya J Manag Care Spec Pharm Research BACKGROUND: Overactive bladder (OAB) is a common medical condition with significant economic and humanistic burden. Inadequately managed OAB may exacerbate or result in comorbidities such as depression, falls, and urinary tract infections, which can further increase the burden to the health care system. Anticholinergics are often prescribed for management of OAB with urinary incontinence (“wet” OAB). However, research has shown that patient adherence and persistence to anticholinergic therapy is poor, with approximately 80% of patients ultimately failing their first prescribed anticholinergic medication within the first year. While there has been a fair amount of research on the economic burden of OAB, the real-world impact of initiating anticholinergic therapy in patients with wet OAB has not been well studied. OBJECTIVE: To compare falls/fractures, anxiety/depression, health care resource utilization, and health care costs between a cohort of patients with wet OAB who initiated anticholinergic therapy and a matched cohort of patients without OAB. METHODS: This study was a retrospective medical and pharmacy claims analysis. Cases were members of a primary care-based, multispecialty physician medical group located in California. Cases were eligible for inclusion if they were prescribed anticholinergic therapy between January 2008 and May 2012 based on pharmacy claims, had a diagnosis of OAB, and reported having ≥ 1 urinary incontinence episode per day. Wet OAB cases were matched to non-OAB controls in a 1:3 ratio based on sex, age, and observation time. Medical and pharmacy claims data were used to analyze patient comorbidities, as well as track health care resource utilization (HRU) and direct payer costs. RESULTS: After initiating anticholinergic therapy, wet OAB patients had a 46% higher adjusted risk of experiencing falls/fractures (P < 0.001) and a 33% higher adjusted risk of experiencing depression/anxiety (P = 0.022) than non-OAB patients. Wet OAB was significantly associated with increased HRU rates of hospital admissions, outpatient visits, prescriptions filled, and diagnostic tests performed. After adjustment for covariates, total health care cost was 33% higher for wet OAB patients than non-OAB patients, resulting in an increased cost of $1,746 per member per year. CONCLUSIONS: The findings of this research suggest OAB patients who initiate anticholinergic therapy and still experience incontinence are at a greater risk for comorbidities such as falls/fractures and depression/anxiety, and use significantly more health care resources, than patients without OAB. Programs to improve patient monitoring and referrals, the appropriate use of alternative treatments within guidelines, and adherence to evidence-based practice parameters may improve clinical outcomes and decrease HRU for these patients. Academy of Managed Care Pharmacy 2016-04 /pmc/articles/PMC10397717/ /pubmed/27023694 http://dx.doi.org/10.18553/jmcp.2016.22.4.406 Text en © 2016, Academy of Managed Care Pharmacy. All rights reserved. https://creativecommons.org/licenses/by/4.0/This article is licensed under a Creative Commons Attribution 4.0 International License, which permits unrestricted use and redistribution provided that the original author and source are credited.
spellingShingle Research
Yehoshua, Alon
Chancellor, Michael
Vasavada, Sandip
Malone, Daniel C.
Armstrong, Edward P.
Joshi, Manher
Campbell, Karen
Pulicharam, Riya
Health Resource Utilization and Cost for Patients with Incontinent Overactive Bladder Treated with Anticholinergics
title Health Resource Utilization and Cost for Patients with Incontinent Overactive Bladder Treated with Anticholinergics
title_full Health Resource Utilization and Cost for Patients with Incontinent Overactive Bladder Treated with Anticholinergics
title_fullStr Health Resource Utilization and Cost for Patients with Incontinent Overactive Bladder Treated with Anticholinergics
title_full_unstemmed Health Resource Utilization and Cost for Patients with Incontinent Overactive Bladder Treated with Anticholinergics
title_short Health Resource Utilization and Cost for Patients with Incontinent Overactive Bladder Treated with Anticholinergics
title_sort health resource utilization and cost for patients with incontinent overactive bladder treated with anticholinergics
topic Research
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10397717/
https://www.ncbi.nlm.nih.gov/pubmed/27023694
http://dx.doi.org/10.18553/jmcp.2016.22.4.406
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