title: Evaluating Outcomes in Patients with Overactive Bladder within an Integrated Healthcare Delivery System Using a Treatment Patterns Analyzer.
abstract: BACKGROUND
  Overactive bladder (OAB) is a relatively common disease that has been linked to a variety of comorbidities, reductions in quality of life, and increased healthcare costs. Antimuscarinic agents are the standard of care among pharmacologic treatments for OAB, but these drugs are linked to high levels of anticholinergic burden, especially in the elderly.
  
  
  OBJECTIVE
  To demonstrate how efficient data analysis can be used to identify gaps in care as a result of improvement strategies for OAB within an integrated healthcare delivery system setting.
  
  
  METHODS
  We developed an OAB treatment patterns analyzer, a clinical outcomes software analysis program, to identify gaps in care, high anticholinergic burden, and potential quality improvement initiatives. Deidentified pharmacy and medical claims data from an integrated delivery network were imported into the OAB treatment patterns analyzer. Patients with a diagnosis of OAB who were continuously enrolled in the network between January 1, 2009, and December 31, 2013, were identified and were imported into the analyzer. The analyzer used National Drug Code;International Classification of Diseases, Ninth Edition, Clinical Modification;Current Procedural Terminology; and UB-92 codes to measure treatment patterns, comorbid conditions, anticholinergic burden, concomitant use with anticholinesterases, costs, and healthcare resource utilization.
  
  
  RESULTS
  Of 157,710 members in the integrated delivery network population, 7309 patients met the study eligibility criteria. Of patients taking medications for OAB, 85% were nonadherent and 73% discontinued treatment within 1 year. Among 1147 patients in the integrated healthcare delivery system who were using medications for OAB, 39 (3.4%) patients were concomitantly taking anticholinesterase drugs and an antimuscarinic agent. The per-month plan-paid cost per member was $318.67. Of all the patients with OAB within the population, the rates of all-cause office visits, emergency department visits, and hospitalizations were 81%, 6%, and 4%, respectively. The rate of clinically relevant anticholinergic burden was 16%, with higher rates among patients with dementia who were also receiving a branded (20%) or generic (24%) antimuscarinic drug.
  
  
  CONCLUSIONS
  In patients using medications for the treatment of OAB, the rates of medication persistence and adherence were poor. Antimuscarinic medications may place certain patient populations at risk for increased anticholinergic burden. Data included in the analyzer can be used to implement member-specific strategies to prevent poor outcomes and reduce associated healthcare costs and utilization.
authors.affiliation: Associate Director, Health Economics and Clinical Outcomes Research, Astellas Pharma Global Development, Northbrook, IL.
authors.forename: Daniel B
authors.initials: DB
authors.lastname: Ng
authors.affiliation: Assistant Director, Global Health Economics and Outcomes Research, Xcenda, Palm Harbor, FL.
authors.forename: Melissa
authors.initials: M
authors.lastname: McCart
authors.affiliation: Senior Software Engineer, Technology and Innovation, Xcenda.
authors.forename: Christopher
authors.initials: C
authors.lastname: Klein
authors.affiliation: Assistant Director, Global Health Economics and Outcomes Research, Xcenda.
authors.forename: Chelsey
authors.initials: C
authors.lastname: Campbell
authors.affiliation: Pharmacoeconomics Unlimited, San Diego, CA.
authors.forename: Robert
authors.initials: R
authors.lastname: Schoenhaus
authors.affiliation: Director, Health Economics and Clinical Outcomes Research, Astellas Scientific and Medical Affairs, Northbrook, IL.
authors.forename: Todd
authors.initials: T
authors.lastname: Berner
keywords: adherence; anticholinergic drugs; antimuscarinic drugs; drug utilization management; genitourinary system; healthcare utilization; overactive bladder; persistence; pharmacy practice; quality improvement