Over the past decade, there has been an increase in therapies available to patients with idiopathic overactive bladder (OAB) in the United States. Most notably, Mirabegron gained FDA approval in 2012 as an oral therapy, and OnabotulinumtoxinA (BTX) bladder injections received FDA approval in 2013. The goal of our study was to determine the trends in the use of these new therapies on a national level.

We queried Optum, a national administrative health and pharmacy claims database, for patients with both medical and prescription drug coverage by private insurance and Medicare Part D between 2003-2015. Patients with non-neurogenic OAB were identified by ICD9 and ICD10 diagnosis codes. Interventions were grouped by oral medication (Anticholinergic therapy, Mirabegron), BTX therapy, sacral neuromodulation (SNS), and peripheral tibial nerve stimulation (PTNS).

2,339,787 patients with OAB were identified. Of these, 523,218 patients (22.3%) were treated. Mean age was 60.9, with 74% of those treated being women. Trends in types of intervention amongst treated OAB patients are shown in Table 1. Mirabegron use increased to 29% in 2015, while anticholinergic therapy decreased from 90% in 2012 to 77% in 2015. BTX therapy decreased from 7.38% in 2013 to 5.2% in 2015. SNS use remained at 1% from 2011-2015. PTNS rates remained low, at less than 1% in all years captured.

A rise in Mirabegron use in 2012 coincides with a decline in anticholinergic and BTX use for management of OAB, suggesting that patients are increasingly utilizing Mirabegron. PTNS and SNS use remained low over time.

Rates of use of advanced therapies for treatment of refractory OAB remain low over a 12-year period. Further research is needed to determine whether newer oral therapies are more efficacious or whether third line therapies are not being fully utilized.