Socioeconomic Factors May Affect Advanced OAB Therapy Use

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Race and educational attainment are among factors found to influence use of advanced OAB treatments among commercially insured patients.
Race and educational attainment are among factors found to influence use of advanced OAB treatments among commercially insured patients.

PHILADELPHIA—Use of advance overactive bladder (OAB) therapies is low among commercially insured patients, and various socioeconomic factors appear to influence patient selection of those treatments, according to a study presented at the International Continence Society's 2018 annual meeting.

Using Optum, a national administrative health and pharmacy claims database, Raveen Syan, MD, and colleagues at Stanford University in Palo Alto, California identified 2,446,652 patients with non-neurogenic OAB. Of these, 519,279 (21.2%) received oral therapies and/or advanced therapies. The investigators found that 17% of the overall study population patients received oral therapies and less than 1% went on to receive advanced therapy.

Compared with whites, Asians and Hispanics were significantly less likely to undergo advanced OAB therapies, said Dr Syan, who presented study findings. Patients with less than a bachelor's degree, those younger than 65 years, and homemakers or retirees are more likely to undergo advanced OAB therapy.

“While commercial insurance coverage may provide access to advanced therapies, numerous socioeconomic factors appear to drive advanced therapy treatment patterns,” Dr Syan told listeners.

Asians were more likely to receive onabotulinumtoxinA treatment, whereas whites were more likely to undergo sacral neuromodulation therapy and peripheral tibial nerve stimulation, she said.

On multivariate analysis, Asian and Hispanic patients had significant 24% and 7% reduced odds of undergoing advanced treatment compared with whites. Compared with patients who had a bachelor's degree or higher educational attainment, those with a high school diploma or less than a 12th grade education had significant 16% and 36% increased odds of receiving advanced treatment, respectively. Patients aged less than 65 years had significant 23% increased odds of advanced treatment compared with older patients. Homemakers or retirees had significant 15% increased odds of advanced treatment compared with managers, owners, or professionals. Men had significant 7% reduced odds of advanced therapy compared with women.

Prior use of oral OAB medications was associated with significant 74% increased odds of advanced therapy.

Study strengths included use of a large diverse population and a commercially insured population, which reduced health coverage as a confounder, Dr Syan said. Limitations include reliance on the accuracy of recorded claims data and lack of patient symptom data.

Reference

Syan R, Zhang C, Enemchukwu E. Do health disparities exist in the insured refractory OAB patient population? Data presented at the International Continence Society's 2018 annual meeting in Philadelphia, August 28–31. Abstract 274.

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