Assessment of treatment-seeking behavior and healthcare utilization in an international cohort of subjects with overactive bladder

Abstract

Objective:

To assess the association between incontinence severity, treatment-seeking behavior, and healthcare resource utilization (HRU) among participants with overactive bladder (OAB) in eight countries.

Research design and methods:

A cross-sectional online survey of subjects ≥18 years old in Australia, Europe, and North America, who had a past OAB diagnosis and/or experienced ≥1 urinary incontinence (UI) episode in the preceding 12 months, were eligible to participate. Subjects contacted for the survey were primarily from a voluntary medication monitoring registry, MediGuard. Predominantly stress incontinence subjects were excluded. Incontinence severity was assessed by the number of UI episodes over 3 days and grouped as 0 (‘dry’), 1–2, 3–4, and ≥5 UI episodes/day. Subject demographics, employment status, comorbidities, treatment-seeking behavior (past OAB diagnosis; spoken to healthcare provider [HCP]), and HRU (diagnostic tests; HCP visits in 6 months before screening) were analyzed by incontinence severity.

Results:

Overall, 1341 subjects with OAB (mean age 54.5 years; 70.7% female) were surveyed; 20.2%, 47.7%, 18.8%, and 13.3% of subjects reported 0, 1–2, 3–4, and ≥5 UI episodes/day, respectively. Employment status and comorbidities were significantly (p < 0.05) associated with incontinence severity. The two measures of treatment-seeking behavior were significantly (p < 0.05) associated with incontinence severity groups; the proportion of subjects with a past diagnosis of OAB were 35.8%, 44.8%, 52.4%, and 64.0% in the 0, 1–2, 3–4, and ≥5 UI episodes/day groups, respectively; and 59.0%, 63.6%, 65.9%, and 78.1% of subjects in the respective UI severity groups talked to a HCP about their OAB symptoms. Multivariate linear regression analyses showed a positive and consistent association between incontinence severity and HRU; subjects reported a mean of 2.7, 4.1, 4.4, and 7.7 diagnostic tests overall (p < 0.001), and a mean of 1.4, 2.2, 2.7, and 4.0 HCP visits in the 0, 1–2, 3–4, and ≥5 UI episodes/day groups, respectively (p < 0.001). A potential limitation of the study is the cross-sectional survey methodology which limits the ability to draw causal inferences from the results. Additionally, since this is a web-based survey it is possible respondents who have access to/are familiar with technology were more likely to be enrolled.

Conclusions:

Incontinence severity was positively associated with both treatment-seeking behavior and HRU among subjects with OAB.

Keywords::

• Burden of incontinence
• Healthcare resource utilization
• Incontinence severity
• Overactive bladder
• Treatment-seeking behavior
• Urinary incontinence
• Urinary symptoms

Transparency

Declaration of funding

This study was funded by Allergan, Inc. Data were collected by Quintiles Inc. and were monitored and analyzed by Allergan, Inc.

All authors were involved in data analysis and interpretation, drafting of the manuscript, and critical revision of the manuscript for important intellectual content. All authors provided final approval to submit the manuscript.

Declaration of financial/other relationships

M.J.-C. has disclosed that he has received grant/research support from Astellas Pharma SA, has been a consultant to Allergan and Astellas Pharma, and has participated in a speaker’s bureau for Allergan, Astellas Pharma, and Medtronic. P.C. has disclosed that he has been a consultant to Allergan. A.S. has disclosed that he has received grant/research support from Allergan, AMS, and Astellas, and has participated in a speaker’s bureau for Astellas and Pfizer. C.P.S. has disclosed that he has been a consultant/advisor to Allergan and has participated in a speaker’s bureau for Allergan. S.H. has disclosed that he has received grant/research support from Allergan, Astellas, and Pfizer, and has been a consultant/advisor to Astellas, Pfizer, Allergan, Lilly, Promedon, and Merus. D.N.-M. and A.D. have disclosed that they are employees of Allergan, Inc. K.T. has disclosed that she is a student at the University of Arizona College of Pharmacy, Tucson, AZ, USA and is on a 1 year fellowship at Allergan, Inc.

CMRO peer reviewers on this manuscript have no relevant financial or other relations to disclose.

Acknowledgments

The authors acknowledge Denise Globe and Patrick Gillard from Allergan, Inc., for their contribution to the conceptualization of the study, development of the study methods, and initiation of the survey. The authors acknowledge Quintiles Inc. for conducting the study for Allergan, Inc. Assistance with writing and development of the manuscript was provided by Jaya Kolipaka of Evidence Scientific Solutions, Philadelphia, PA, and was funded by Allergan, Inc.

Previous presentation: Presented at the International Continence Society (ICS) 43rd Annual Meeting, 26–30 August 2013, Barcelona, Spain.