Overactive bladder (OAB) is a condition based on the development of symptoms of urgency, usually with frequency and nocturia, with or without urge urinary incontinence. Real-world utilization data of second-line pharmacological treatments for OAB and the impact of navigated care through the OAB treatment pathway are limited. The objective was to describe real-world utilization patterns of second-line pharmacological treatments for OAB stratified by those who did or did not receive navigated care.

Patients with OAB were randomly and retrospectively identified using the ninth and tenth revisions of the International Classification of Diseases, Clinical Modification and procedure codes from the Precision Point Specialty Analytics Portal for OAB database. This database contains the electronic medical record data for >90 US community-based urology practices for ≈2.4 million OAB patients. Eligible patients were ≥18 years of age, newly diagnosed and treated for OAB between January 1, 2015, and December 31, 2019, and had ≥2 OAB visits ≥30 days apart. A treatment navigator was identified as a health professional focused on individualized patient-centered care by assisting in the guidance of the patient through the OAB clinical pathway. Use of second-line treatment medications during the study period was collected. The date of discontinuation of initial second-line treatment, identified by a physician or navigator, began when a different OAB treatment was used without continuing the prior treatment. A switch in second-line treatment was defined as starting a new treatment within 30 days of discontinuing initial second-line treatment. Proportions were compared using chi-squared tests. Time-to-event data were compared using log-rank tests.

Of 190,697 patients who met all inclusion criteria, 9000 were randomly selected. Overall, 95.8% (n=8623) of patients received second-line treatment of which 56.2% received an anticholinergic and 41.7% received a beta-3 agonist. Of those patients receiving second-line treatment, 60.2% received 1 medication, 27.3% received 2 medications, and 12.6% received 3+ medications. 9% of patients receiving second-line treatment switched treatment within 30 days with no difference between the navigated or non-navigated patients. Of all patients starting a second-line treatment, 70.2% (n=6051/8623) discontinued treatment during the study timeframe. Of patients who discontinued their initial second-line treatment, 59.1% discontinued anticholinergics and 39.1% discontinued beta-3 agonists. 62.5% of the patients who discontinued had navigated care compared with 71.3% who were not under navigated care (P<0.001). Discontinuations were lower in patients who received navigated care and follow-up visits (61.4% of patients) compared with navigated patients who did not have follow-up visits (71.1% of patients, P=0.042).

The present analysis suggests that patients with OAB that had navigator-based care had a lower rate of discontinuation of second-line treatment compared to patients without navigated care. The discontinuation of second-line treatment further decreased in navigated patients who had follow up visits.

While having a patient navigator with follow up visits leads to less discontinuation of second-line treatments, this rate is still above 60%. This suggests that advancing to treatment options beyond second-line treatments may be of interest to some patients with OAB seeking symptom management.

Continence 2S2 (2022) 100367
DOI: 10.1016/j.cont.2022.100367