Department of Obstetrics and Gynecology, Mayo Clinic.
From the Department of Urology, Mayo Clinic.
Female Pelvic Med Reconstr Surg. 2021 Feb 1;27(2):e261-e266. doi: 10.1097/SPV.0000000000000744.
The aim of this study was to evaluate national patterns of care for women with overactive bladder (OAB) in an administrative data set and identify potential areas for improvement.
We performed an analysis using the OptumLabs Data Warehouse, which contains deidentified administrative claims data from a large national US health insurance plan. The study included women, older than 18 years, with a new OAB diagnosis from January 1, 2007, to June 30, 2017. We excluded those with an underlying neurologic etiology, with interstitial cystitis/painful bladder syndrome, were pregnant, or did not have continuous enrollment for 12 months before and after OAB diagnosis. Trends in management were assessed via the Cochran-Armitage test. Time to discontinuation among medications was compared using t test.
Of 1.4 million women in the database during the study time frame, 60,246 (4%) were included in the study. Median age was 61 years [interquartile range (IQR), 50-73], and median follow-up was 2.6 years (IQR, 1.6-4.2). Overall, 37% were treated with anticholinergics, 5% with beta-3 agonists, 7% with topical estrogen, and 2% with pelvic floor physical therapy; 26% saw a specialist; and 2% underwent third-line therapy. Median time to cessation of prescription filling was longer for beta-3 agonists versus anticholinergics [median, 4.1 months (IQR, 1-15) vs 3.6 months (IQR, 1-10); P < 0.0001]. Use of third-line therapies significantly increased over the study time frame, from 1.1% to 2.2% (P < 0.0001).
Most of the patients do not continue filling prescriptions for OAB medications, and a minority of patients were referred for specialty evaluation. Although third-line therapy use is increasing, it is used in a small proportion of women with OAB. Given these patterns, there may be underutilization of specialist referral and other OAB therapies.
本研究旨在利用行政数据集评估患有膀胱过度活动症（OAB）的女性的全国护理模式，并确定潜在的改进领域。
我们利用 OptumLabs 数据仓库进行了分析，该数据仓库包含来自美国大型医疗保险计划的匿名行政索赔数据。研究纳入了年龄大于 18 岁、2007 年 1 月 1 日至 2017 年 6 月 30 日期间新诊断为 OAB 的女性。我们排除了有潜在神经病因、间质性膀胱炎/疼痛性膀胱综合征、怀孕或在 OAB 诊断前后 12 个月内未连续参保的患者。通过 Cochran-Armitage 检验评估管理趋势。使用 t 检验比较药物停药时间。
在研究期间，数据库中有 140 万名女性，其中 60246 名（4%）被纳入研究。中位年龄为 61 岁[四分位距（IQR），50-73]，中位随访时间为 2.6 年（IQR，1.6-4.2）。总体而言，37%的患者接受了抗胆碱能药物治疗，5%的患者接受了β3 激动剂治疗，7%的患者接受了局部雌激素治疗，2%的患者接受了盆底物理治疗；26%的患者就诊于专科医生，2%的患者接受了三线治疗。与抗胆碱能药物相比，β3 激动剂的处方停药中位时间更长[中位数，4.1 个月（IQR，1-15）比 3.6 个月（IQR，1-10）；P <0.0001]。在研究期间，三线治疗的使用率显著增加，从 1.1%增加到 2.2%（P <0.0001）。
大多数患者不再继续开具 OAB 药物处方，少数患者接受了专科评估。尽管三线治疗的使用率在增加，但仅在一小部分 OAB 女性中使用。鉴于这些模式，可能存在专科转诊和其他 OAB 治疗的利用率不足。
