Impact of socioeconomic factors and frailty on oral overactive bladder therapy utilization in medicare part d beneficiaries

You have accessJournal of UrologyCME1 Apr 2023MP74-06 IMPACT OF SOCIOECONOMIC FACTORS AND FRAILTY ON ORAL OVERACTIVE BLADDER THERAPY UTILIZATION IN MEDICARE PART D BENEFICIARIES Ekene A. Enemchukwu, Hodan Mohamud, Amy Zhang, Meredith West, Jennifer Anger, and Charles Scales Ekene A. EnemchukwuEkene A. Enemchukwu More articles by this author , Hodan MohamudHodan Mohamud More articles by this author , Amy ZhangAmy Zhang More articles by this author , Meredith WestMeredith West More articles by this author , Jennifer AngerJennifer Anger More articles by this author , and Charles ScalesCharles Scales More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000003348.06AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: Overactive bladder (OAB) is a chronic debilitating condition. Frailty is associated with age but is increasingly recognized as a more impactful determinant of health outcomes than chronological age. Increasing frailty and age are associated with OAB. Given the impact of OAB on quality of life multiple societies recommend treatment but advise caution in frail patients. The American Urologic Association advises caution when prescribing antimuscarinics in frail elderly patients and patients with dementia, severe constipation, or baseline anticholinergic use, recommending the use of beta 3 agonists alternatively. This study aimed to describe the prevalence of frailty in OAB Medicare beneficiaries and evaluate the impact of frailty on oral OAB therapy utilization patterns. METHODS: Medicare beneficiaries ≥65 years old with a diagnosis of OAB were examined between 2013 and 2018. Beneficiaries were stratified using the Claims-Based Frailty Index (CFI) into 3 categories: not frail (CFI<0.15), prefrail (0.15≤CFI<0.25) and frail (CFI>0.25). Cox proportional hazard regression models were used to assess the impact of frailty status and socioeconomic status (SES) on mirabegron utilization using Medicare Part D prescription claims data. A test of collinearity was performed. RESULTS: A total of 109,274 patients (15.4% of the overall OAB cohort) treated with antimuscarinics or mirabegron were identified during the study period of whom 71% were women and 81% were White. Overall 12,963 (11.9%) were frail. On multivariate analysis, advancing age (HR 1.33), White and Asian race (HR 1.20), urology (HR 1.79) and gynecology (HR 1.62) providers, South region (HR 1.53), and dual-eligible status (HR 1.13) were independently associated with mirabegron utilization. Frailty (HR 0.95) was not independently associated with mirabegron utilization. CONCLUSIONS: Age, race, SES, Medicare region and provider type were independently associated with filled mirabegron prescriptions while frailty was not. Urology and gynecology patients were more likely to fill mirabegron than primary care and other medical specialists. The study highlights the importance of evaluating for both frailty and age and the need to educate providers on the concerns of prolonged antimuscarinic use for frail and older OAB patients. Source of Funding: NICHD R25 HD094667, NIH NIDDK K23 DK131315-01A1 © 2023 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 209Issue Supplement 4April 2023Page: e1071 Advertisement Copyright & Permissions© 2023 by American Urological Association Education and Research, Inc.MetricsAuthor Information Ekene A. Enemchukwu More articles by this author Hodan Mohamud More articles by this author Amy Zhang More articles by this author Meredith West More articles by this author Jennifer Anger More articles by this author Charles Scales More articles by this author Expand All Advertisement PDF downloadLoading ...