Emory University School of Medicine, Atlanta, Georgia, USA.
Astellas Pharma Global Development Inc., Northbrook, Illinois, USA.
Neurourol Urodyn. 2022 Nov;41(8):1872-1889. doi: 10.1002/nau.25040. Epub 2022 Sep 13.
Overactive bladder (OAB) and frailty are independently associated with patient burden. However, economic burden and treatment-taking behavior have not been well characterized among frail patients with OAB, which, given the varying safety and tolerability profiles of available treatments, is crucial.
To assess costs, health care resource utilization, treatment-taking behavior (persistence and adherence) to OAB medication in older, frail OAB patients.
This was a retrospective cohort study using international business machines MarketScan Medicare Supplemental claims data. Eligible frail patients (per Claims-based Frailty Index score) initiating mirabegron were 1:2 propensity score matched (based on age, sex, and other characteristics) with those initiating antimuscarinics and were followed up to 1 year. All-cause, per-person, per-month costs, health care encounters, persistence (median days to discontinuation assessed using Kaplan-Meier methods) and adherence (≥80% of proportion of days covered at Day 365) were compared.
From 2527 patients with incident mirabegron (21%) or antimuscarinic (79%) dispensations, 516 incident mirabegron users (median age: 82 years, 64% female) were matched to 1032 incident antimuscarinic users (median age: 81 years, 62% female). Median cost was higher in mirabegron group ($1581 vs. $1197 per month); this was primarily driven by medication cost. There was no difference in medical encounters. Adherence (39.1% vs. 33.8%) and persistence (103 vs. 90 days) were higher in mirabegron users.
Among frail older adults with OAB, mirabegron use was associated with higher costs and potential improvements in treatment-taking behaviors, particularly with respect to treatment adherence, versus those initiating antimuscarinics.
膀胱过度活动症（OAB）和虚弱与患者负担独立相关。然而，在患有 OAB 的虚弱患者中，经济负担和治疗用药行为尚未得到很好的描述，鉴于现有治疗方法的安全性和耐受性各不相同，这一点至关重要。
评估在年龄较大、虚弱的 OAB 患者中，使用米拉贝隆治疗 OAB 的成本、医疗资源利用情况以及治疗用药行为（持续性和依从性）。
这是一项回顾性队列研究，使用了 IBM MarketScan Medicare 补充索赔数据。符合条件的虚弱患者（根据基于索赔的虚弱指数评分）起始米拉贝隆治疗者按 1：2 进行倾向评分匹配（基于年龄、性别和其他特征），与起始使用抗毒蕈碱药物的患者进行匹配，并随访 1 年。比较全因、人均、每月成本、医疗就诊次数、持续性（采用 Kaplan-Meier 方法评估停药的中位天数）和依从性（第 365 天时≥80%的比例天数覆盖）。
在 2527 例起始米拉贝隆（21%）或抗毒蕈碱药物（79%）用药的患者中，516 例起始米拉贝隆使用者（中位年龄：82 岁，64%为女性）与 1032 例起始抗毒蕈碱药物使用者（中位年龄：81 岁，62%为女性）进行了匹配。米拉贝隆组的中位成本更高（每月 1581 美元 vs. 1197 美元）；这主要是由药物成本驱动的。两组的医疗就诊次数没有差异。米拉贝隆使用者的依从性（39.1% vs. 33.8%）和持续性（103 天 vs. 90 天）更高。
在患有 OAB 的虚弱老年患者中，与起始使用抗毒蕈碱药物相比，起始使用米拉贝隆与更高的成本和潜在改善的治疗用药行为相关，尤其是在治疗依从性方面。
