Hypothesis / aims of study
Documenting the disease burden of non-neurogenic, non-obstructive underactive bladder (UAB) using insurance claims alone is difficult due to the absence of UAB-specific ICD-10-CM codes. To address the limitations of claims data, this study used a combination of large United States datasets linking claims, electronic health records (EHR), and clinical notes to characterize diagnostic and treatment patterns, and burden of UAB.
Study design, materials and methods
A retrospective analysis of medical and pharmacy claims linked to structured EHR and clinical notes data was performed.
Claims, EHR, and clinical notes data were licensed from HealthVerity. Eligibility criteria included a visit to a urologist between Jan 1, 2021 - Dec 31, 2022 (case identification period; CIP) for a lower urinary tract symptom and age > 19. Exclusion criteria included known neurologic etiology of urinary dysfunction (e.g., spinal cord injury). Individuals were classified with probable UAB if they had urinary retention, weak urinary stream, or voiding dysfunction and no evidence of obstruction. Index date was the first urologist visit for urinary symptoms during CIP. The follow-up period was the 24-months post-index. Outcomes included symptoms, urodynamic testing (UDS), treatment utilization, complications, healthcare resource use, and cost.
Results
Of 155,383 adults with urology visits for urinary symptoms, 26.9% met criteria for probable UAB. During follow up, diagnostic testing included post-void residual (47.8%), bladder cystometry (11.2%), bladder electromyography (11.2%), flow rates (0.3%), and none (47.5%). UAB treatment during follow up included intermittent catheterization (15.7%), indwelling catheterization (13.7%), pharmacotherapy (13.8%, predominantly with alpha-blockers), bladder muscle rehabilitation (4.0%), sacral neuromodulation (1.9%), and no treatment (67.7%). Adverse outcomes during follow up included UTIs (43.0%), anxiety (40.0%), depression (28.5%), nocturia (20.2%), and hydronephrosis (6.1%). UAB-associated costs during follow up are estimated at $2,534.
Interpretation of results
Non-neurogenic UAB is common, burdensome, and often untreated. While UAB is associated with substantial clinical and psychosocial burden, limited treatment options and associated complications reflect a major unmet need.
Concluding message
Underutilization of UDS may be a result of a lack of treatment options, highlighting the need for improvements in diagnostic testing and novel therapeutic options. Additionally, cost assessments based solely on medical claims substantially underestimate the true real-world burden of UAB, which have been estimated by other sources to range from $2,000 to over $12,000 per year, with lifetime costs surpassing $110,000[1]. These claims-based assessments often exclude expenses such as out-of-pocket purchases of incontinence supplies and catheters, as well as losses in caregiver productivity costs that may be significant on a daily basis.