(191) Utilization of Medications for Overactive Bladder / Urinary Incontinence during 2018-2022: Analysis of the Medicare Part C and D Prescribers - by Provider and Drug Dataset

Background: : Anticholinergic drugs for overactive bladder (OAB) and urinary incontinence (UI) can have significant side effects among older adults.

Objective: : To determine trends in Medicare utilization of anticholinergic and β3-agonist medications for OAB/UI, overall, and by US region and by prescriber type.

Methods: : We conducted a series of cross sectional analyses using the Medicare Part C and D Prescribers – by Provider and Drug databases. Claims for anticholinergic OAB/UI agents and β3-agonists were extracted, and we examined the total number of 30-day equivalent fills. To account for yearly changes in enrollment, we calculated the number of 30-day claims per 1,000 Medicare beneficiaries. The annual number of claims for anticholinergic and β3 agonist OAB/UI drugs per 1,000 beneficiaries was determined for each year during 2018-2022, by US Census region, and for urologist and non-urologist prescribers, with 99% confidence intervals.

Results: : The number of claims for anticholinergic OAB/UI drugs per 1,000 beneficiaries decreased over time, from 233.88 in 2018 (99% CI 233.69-234.07) to 203.06 in 2022 (99% CI 202.90-203.22), representing a 13.2% decline. Conversely, the number of claims for β3 agonist OAB/UI drugs per 1,000 beneficiaries increased over time, from 60.29 in 2018 (99% CI 60.20-60.39) to 96.04 in 2022 (99% CI 95.93-96.15), representing a 59.3% rise. Annual claims for any OAB/UI medication rose slightly during this timeframe by 1.7%. The proportion of OAB/UI claims that were β3-agonists rose from 20.49% (99% CI: 20.48–20.51) in 2018, to 32.00% (99% CI: 31.98–32.02) in 2022. In 2022, the Northeast had the highest proportion of OAB/UI claims for β3-agonists, at 36.61% (99% CI: 36.56–36.65), while the Midwest had the lowest proportion at 27.69% (99% CI: 27.66–27.73). In 2022, urologists prescribed β3-agonists for 40.02% (99% CI: 39.98–40.05) of OAB/UI claims, while the proportion was 29.29% (99% CI: 29.27–29.31) for
non-urologists. From 2018 to 2022, claims for β3-agonists rose by 8.99 percentage points (28.96% relative) among urologists and 12.55 points (74.97% relative) among non-urologists.

Conclusions: : Claims for medications for OAB/UI remained steady between 2018-2022, yet the use of β3-agonists increased over time, while the use of anticholinergic drugs declined. Differences in β agonist use were observed by US region and by prescriber specialty. While urologists
prescribed β3-agonists at higher rates than non-urologists, the increase in β3-agonist claims among non-urologists suggests a broader shift toward these safer therapies in general practice.

Sponsorship:: None