title: Health Resource Utilization and Cost for Patients with Incontinent Overactive Bladder Treated with Anticholinergics.
abstract: 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.
  
  
  BACKGROUND
  This study was sponsored by Allergan, Irvine, California, which reviewed and approved the final manuscript. At the time of the study, Yehoshua had received a fellowship at the University of Arizona, which was funded by Allergan. Yehoshua, Joshi, and Campbell are employees of Allergan. Vasaveda has received consulting fees from Allergan, Medtronic, and Boston Scientific. Chancelor has received consulting fees from Allergan and Medtronic. All authors met the ICMJE authorship criteria. Neither honoraria nor payments were made for authorship. Study design was created by Yehoshua, Pulicharam, Malone, and Armstrong. Pulicharam took the lead in data collection, along with Chancellor and Campbell, and data interpretation was performed by Chancellor, Vasavada, Malone, and Armstrong. The manuscript was written by Yehoshua and revised by Joshi and Yehoshua, with assistance from the other authors.
authors.affiliation: 1 Global Health Economics and Outcomes Research Manager, Allergan, Irvine, California.
authors.forename: Alon
authors.initials: A
authors.lastname: Yehoshua
authors.affiliation: 2 Professor of Urology and Director of the Aikens Neurourology Center, Beaumont Health System, Oakland University William Beaumont School of Medicine, Oakland, California.
authors.forename: Michael
authors.initials: M
authors.lastname: Chancellor
authors.affiliation: 3 Urologic Director, Center for Female Pelvic Medicine and Reconstructive Surgery, Cleveland Clinic, Cleveland, Ohio.
authors.forename: Sandip
authors.initials: S
authors.lastname: Vasavada
authors.affiliation: 4 Professor, The University of Arizona, Tucson, Arizona.
authors.forename: Daniel C
authors.initials: DC
authors.lastname: Malone
authors.affiliation: 5 Professor Emeritus, The University of Arizona, Tucson, Arizona.
authors.forename: Edward P
authors.initials: EP
authors.lastname: Armstrong
authors.affiliation: 6 Senior Director Medical Affairs, Allergan, Irvine, California.
authors.forename: Manher
authors.initials: M
authors.lastname: Joshi
authors.affiliation: 7 Senior Medical Scientific Manager, Allergan, Irvine, California.
authors.forename: Karen
authors.initials: K
authors.lastname: Campbell
authors.affiliation: 8 Medical Director, Population Health Management & Clinical Outcomes, Healthcare Partners, Los Angeles, California.
authors.forename: Riya
authors.initials: R
authors.lastname: Pulicharam
mesh_terms: D000058:Accidental Falls / Q000706:statistics & numerical data; D000368:Aged; D000369:Aged, 80 and over; D001007:Anxiety / Q000453:epidemiology; D002140:California; D016022:Case-Control Studies; D018680:Cholinergic Antagonists / Q000191:economics / Q000627:therapeutic use*; D003863:Depression / Q000453:epidemiology; D005260:Female; D050723:Fractures, Bone / Q000453:epidemiology; D017048:Health Care Costs / Q000706:statistics & numerical data*; D006295:Health Resources / Q000706:statistics & numerical data; D006801:Humans; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D053201:Urinary Bladder, Overactive / Q000188:drug therapy* / Q000191:economics; D014549:Urinary Incontinence / Q000188:drug therapy* / Q000191:economics
chemical_list: D018680:Cholinergic Antagonists