Patient preferences for treating refractory overactive bladder in the UK.
OBJECTIVE
To evaluate patient preferences for refractory overactive bladder (OAB) treatments: sacral neuromodulation (SNM), onabotulinum toxin A (Botox(®)), and percutaneous tibial nerve stimulation (PTNS).


METHODS
A cross-sectional Web survey was conducted with UK idiopathic OAB patients, recruited by a market research company. Preference was explored using direct questioning, comparing SNM, Botox, and PTNS, and via best-worst scaling (BWS). In BWS, patients prioritized subsets of 13 treatment characteristics (attributes) across 13 choice tasks, identifying the attribute they considered best and worst in each task. The attributes were those that were identified by patients in previous qualitative interviews as influential in treatment selection. BWS scores for each attribute, ranging from 1.0 (most favourable) to -1.0 (most unfavourable), were calculated based on the rates they were identified as best and as worst. To identify attributes that may influence treatment choice, BWS scores were compared among patients based on their most preferred treatment using analyses of variance; pairwise differences were assessed using Tukey's multiple comparisons test.


RESULTS
The study population (N = 139) was 77 % female, had a mean age of 49 years, and were diagnosed a mean of 6.1 years ago. All 13 attribute BWS scores were viewed positively (score > 0.0) or negatively (score < 0.0). Among the 127 (91 %) of patients who had experience with OAB medication only, most (≥80 %) were willing to try each of the three treatments; 57, 34, and 9 % most preferred PTNS, SNM, and Botox, respectively. Preferences for the attributes differed based on which treatment that patients preferred. Specifically, patients preferring SNM (PS) favoured 'implanted device in upper buttock' more than those preferring PTNS (PP) or Botox (PB). Compared to PB, PS also favoured 'sends signals between bladder and brain to help restore bladder function' and 'test phase'. PB favoured 'Botox (botulinum toxin) treatment' and 'treatment procedure delivered through the urethra' more than PS and PP. PP favoured the following more than PS and PB: 'needle inserted into ankle', 'minimal side effects' and 'treatment requires repeated visits over time'.


CONCLUSIONS
This study identified specific characteristics of specialized therapies for refractory OAB that may significantly influence patient preferences, which may be used to help inform treatment decision-making.
Bristol Urological Institute, Bristol, UK. h.hashim@gmail.com.
Hashim
H
Hashim
ORS Health, 3523 Albemarle St. NW, Washington, DC, 20008, USA. Kathy.beusterien@orshealth.com.
Kathleen
K
Beusterien
Department of Health Policy and Management, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA. jbridges@jhsph.edu.
John F P
JF
Bridges
ORS Health, Andover, MA, USA. kaitlan.amos@orshealth.com.
Kaitlan
K
Amos
Urogynaecology Department, King's College Hospital, London, UK. Linda@lindacardozo.co.uk.
Linda
L
Cardozo
D065087:Acetylcholine Release Inhibitors / Q000627:therapeutic use*; D000328:Adult; D019274:Botulinum Toxins, Type A / Q000627:therapeutic use*; D003430:Cross-Sectional Studies; D005260:Female; D019538:Health Care Surveys; D006801:Humans; D058542:Implantable Neurostimulators; D008160:Lumbosacral Plexus; D008297:Male; D008875:Middle Aged; D057240:Patient Preference / Q000706:statistics & numerical data*; D010465:Perception; D019233:Retreatment; D013979:Tibial Nerve; D004561:Transcutaneous Electric Nerve Stimulation; D006113:United Kingdom; D053201:Urinary Bladder, Overactive / Q000188:drug therapy / Q000628:therapy*
D065087:Acetylcholine Release Inhibitors; D019274:Botulinum Toxins, Type A
Botox; Onabotulinum toxin A; Patient preferences; Percutaneous tibial nerve stimulation; Refractory OAB treatment; Sacral neuromodulation