Editorial Comment RE: Yearly Trends of Overactive Bladder Medication Usage

This study used 2013–17 Medicare Part D data to describe trends in claims and medicare expenditure for anticholinergics and beta-3 agonists for treatment of OAB. In 2017 there were 8.8 million claims for OAB medications amounting to $1.6 billion dollars in medication expenditures, a 15% increase in claims and a 58% increase in cost from 2013. Over the study period oxybutynin remained the most commonly prescribed OAB medication (representing 51–54% of all claims) while mirabegron claims increased by 16.5% making it the second most commonly prescribed medication in 2017.

These findings are striking for several reasons. First they highlight the magnitude of OAB among older adults and the importance of efforts to better understand and treat it. Next, a proportionally small increase in claims resulted in a large increase in medication expenditure. As the authors note, the disproportional change may be attributed to the increase in use of mirabegron. Interestingly the rise in mirabegron use was associated with a 10% decrease in the proportion of total claims for anticholinergic alternatives to oxybutynin. This is paradoxical in light of data showing worse adverse event profiles seen with oxybutynin compared to other tertiary amines and a quaternary amines [1] [2]. Next, the fact that only 1/4 of all OAB medication claims in 2017 were prescribed by urologists reinforces the concept that a treatment paradigm spanning primary care and specialists may be ideal.

Finally, the authors should be commended on their ability to synthesize meaningful data based on freely available public use data files. It will be interesting to see how these trends continue beyond 2017.