Utilization of More Than One Minimally Invasive Overactive Bladder Therapy Among Older Adults; a National Medicare Study.

AIMS: Minimally invasive overactive bladder (OAB) therapies (percutaneous tibial nerve stimulation [PTNS], onabotulinumtoxinA [BTX], sacral neuromodulation [SNM]) are commonly used in older adults, however little is known regarding utilization of more than one minimally invasive OAB therapy within 2 years of initiating such treatment. METHODS: This retrospective cohort study included 100% of fee-for-service Medicare beneficiaries who underwent minimally invasive OAB therapy (MIT) from 2015 to 2020. The primary outcome was initiation of a different MIT within 2 years of the index therapy. A Sankey diagram was created to visualize the sequence and flow of therapies. Multivariable modified Poisson regression was performed to identify patient-factors associated with initiating different MIT. RESULTS: Among the 111,939 beneficiaries undergoing first-time MIT, 18,444 (16.5%) initiated different MIT within 2 years. The most common pattern was PTNS followed by BTX (29.1%), then BTX followed by SNM (20.9%) and SNM followed by BTX (20.0%). Factors associated with increased likelihood of initiating different MIT were: PTNS as the index therapy (aRR 1.43, 95% CI 1.38-1.48 vs. SNM), female sex (aRR 1.12, 95% CI 1.09-1.16), and higher frailty levels (pre-frail aRR 1.09, 95% CI 1.06-1.13; mild-to-severe frailty aRR 1.08, 95% CI 1.03-1.14 vs. not frail). Older age (75-84 aRR 0.88, 95% CI 0.86-0.91; ≥ 85 aRR 0.60, 95% CI 0.57-0.63 vs. 65-74 years) and non-White race (aRR 0.79, 95% CI 0.75-0.84) were associated with lower likelihood of initiating different MIT. CONCLUSION: Among Medicare beneficiaries receiving MIT, 16.5% initiated different therapy within 2 years. These high rates of more than one MIT within a short time endorse the need for expectation-setting and close follow-up.