Assessment of treatment-seeking behavior and healthcare utilization in an international cohort of subjects with overactive bladder.
Abstract Objective: To assess the association between incontinence severity, treatment-seeking behavior, and healthcare resource utilization (HRU) among participants with overactive bladder (OAB) in eight countries.


METHODS
A cross-sectional online survey of subjects ≥18 years old in Australia, Europe, and North America, who had a past OAB diagnosis and/or experienced ≥1 urinary incontinence (UI) episode in the preceding 12 months, were eligible to participate. Subjects contacted for the survey were primarily from a voluntary medication monitoring registry, MediGuard. Predominantly stress incontinence subjects were excluded. Incontinence severity was assessed by the number of UI episodes over 3 days and grouped as 0 ('dry'), 1-2, 3-4, and ≥5 UI episodes/day. Subject demographics, employment status, comorbidities, treatment-seeking behavior (past OAB diagnosis; spoken to healthcare provider [HCP]), and HRU (diagnostic tests; HCP visits in 6 months before screening) were analyzed by incontinence severity.


RESULTS
Overall, 1341 subjects with OAB (mean age 54.5 years; 70.7% female) were surveyed; 20.2%, 47.7%, 18.8%, and 13.3% of subjects reported 0, 1-2, 3-4, and ≥5 UI episodes/day, respectively. Employment status and comorbidities were significantly (p < 0.05) associated with incontinence severity. The two measures of treatment-seeking behavior were significantly (p < 0.05) associated with incontinence severity groups; the proportion of subjects with a past diagnosis of OAB were 35.8%, 44.8%, 52.4%, and 64.0% in the 0, 1-2, 3-4, and ≥5 UI episodes/day groups, respectively; and 59.0%, 63.6%, 65.9%, and 78.1% of subjects in the respective UI severity groups talked to a HCP about their OAB symptoms. Multivariate linear regression analyses showed a positive and consistent association between incontinence severity and HRU; subjects reported a mean of 2.7, 4.1, 4.4, and 7.7 diagnostic tests overall (p < 0.001), and a mean of 1.4, 2.2, 2.7, and 4.0 HCP visits in the 0, 1-2, 3-4, and ≥5 UI episodes/day groups, respectively (p < 0.001). A potential limitation of the study is the cross-sectional survey methodology which limits the ability to draw causal inferences from the results. Additionally, since this is a web-based survey it is possible respondents who have access to/are familiar with technology were more likely to be enrolled.


CONCLUSIONS
Incontinence severity was positively associated with both treatment-seeking behavior and HRU among subjects with OAB.
Hospital Universitario Ramon y Cajal , Madrid, Spain.
Miguel
M
Jimenez-Cidre
Pierre
P
Costa
Daisy
D
Ng-Mak
Arun
A
Sahai
Arnold
A
Degboe
Christopher Patrick
CP
Smith
Kathleen
K
Tsai
Sender
S
Herschorn
D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001315:Australia; D015331:Cohort Studies; D003430:Cross-Sectional Studies; D005060:Europe; D005260:Female; D019538:Health Care Surveys; D006296:Health Services / Q000706:statistics & numerical data*; D006801:Humans; D016014:Linear Models; D008297:Male; D008875:Middle Aged; D009656:North America; D010342:Patient Acceptance of Health Care / Q000706:statistics & numerical data*; D057566:Self Report; D012720:Severity of Illness Index; D053201:Urinary Bladder, Overactive / Q000150:complications / Q000175:diagnosis / Q000628:therapy*; D014549:Urinary Incontinence / Q000209:etiology; D055815:Young Adult
Burden of incontinence; Healthcare resource utilization; Incontinence severity; Overactive bladder; Treatment-seeking behavior; Urinary incontinence; Urinary symptoms