Effect of Anticholinergic Burden on Healthcare Costs in Patients With Overactive Bladder: A Retrospective Database Claims Analysis

Speaker(s)

Richter HE1, Chastek B2, Carrera A3, Landis C2, Snyder D3, Abedinzadeh L3, Bancroft T2, Nesheim J3, Dmochowski RR4, Hijaz AK5, Frankel J6
1University of Alabama at Birmingham, Birmingham, AL, USA, 2Optum, Eden Prairie, MN, USA, 3Sumitomo Pharma America, Inc., Marlborough, MA, USA, 4Vanderbilt University Medical Center, Nashville, TN, USA, 5University Hospitals Cleveland Medical Center, Cleveland, OH, USA, 6Seattle Urology Research Center, Seattle, WA, USA

Presentation Documents

OBJECTIVES: To assess the association of anticholinergic burden (ACB) with healthcare costs in patients with overactive bladder (OAB).

METHODS: This retrospective analysis used the Optum Research Database to identify adults with ≥1 pharmacy claim for ≥1 of 6 OAB anticholinergics from January 2010‒November 2021. Patients had ≥6 months continuous health plan enrollment with pharmacy and medical benefits preindex (baseline) and postindex and no OAB anticholinergic claims during baseline. Index was defined as the date of first OAB anticholinergic claim. Patients were followed until disenrollment or 31 May 2022. Daily ACB was calculated using burden scores (based on established burden values and quantity received) and dose over the previous 180 days and categorized from 0 to ≥4 points/day. All-cause healthcare resource utilization (HCRU)-related and event-related (cognitive impairment, falls/fractures) costs were assessed. Marginal structural models (MSM) were used to analyze the association of costs with ACB, minimizing time-varying confounding.

RESULTS: A total of 428,142 patients were identified. Overall, 58.6% of patients were ≥65 years old, 66.7% were female, and 59.5% had Medicare coverage. Mean (SD) baseline ACB was 0.53 (1.44). Analysis at baseline showed total per-patient per-month all-cause healthcare costs increased with ACB (0 points/d, $1793; 1 point/d, $2529; 2 points/d, $2950; 3 points/d, $3133; ≥4 points/d, $3332). Postindex, total all-cause and individual (ambulatory, office, outpatient, and emergency room visits and other medical) healthcare costs generally continued to increase with ACB. Increasing ACB was associated with increased all-cause total healthcare costs (vs 0 points/d; cost ratio range, 1.206–1.546), as well as increased event-related costs (cognitive impairment, 1.206–1.573; falls/fractures, 1.192–1.605).

CONCLUSIONS: In this retrospective claims analysis using MSM to control for time-varying covariates, patients with OAB showed a positive direct correlation with ACB and medical costs related to total all-cause HCRU costs, cognitive impairment, and falls/fractures.

Code

EE251

Topic

Economic Evaluation, Study Approaches

Disease

Drugs, Urinary/Kidney Disorders