Undertreatment of overactive bladder among men with lower urinary tract symptoms in the United States: A retrospective observational study

• Published in: Neurourology and urodynamics Vol. 39; no. 5; pp. 1378 - 1386
• Main Authors: Burnett, Arthur L., Walker, David R., Feng, Qi, Johnston, Karissa M., Lozano‐Ortega, Greta, Nimke, David, Hairston, John C.
• Format: Journal Article
• Language: English
• Published: United States Wiley Subscription Services, Inc 01.06.2020; John Wiley and Sons Inc
• Subjects: Adrenergic alpha-Antagonists - therapeutic use; Adult; Aged; benign prostatic hyperplasia; Diagnosis; Drug Therapy, Combination; Epidemiology; Humans; Hyperplasia; lower urinary tract symptoms; Male; Medical diagnosis; Medicare; Middle Aged; Observational studies; Original Clinical; overactive bladder; Prostatic Hyperplasia - complications; Retrospective Studies; Tadalafil - therapeutic use; United States; Urinary Bladder, Overactive - drug therapy; Urinary Bladder, Overactive - etiology; Urinary tract; Urination; Urological Agents - therapeutic use; United States; epidemiology; lower urinary tract symptoms; overactive bladder; benign prostatic hyperplasia
• ISSN: 0733-2467; 1520-6777
• DOI: 10.1002/nau.24348

Aims To characterize the epidemiology and treatment patterns of adult men (≥40 years) diagnosed with, or treated for, overactive bladder (OAB) and/or benign prostatic hyperplasia (BPH). Methods This retrospective observational study used data extracted from the IBM MarketScan Commercial Claims and Encounters database and the Medicare Supplemental Coordination of Benefits database. Men with BPH and/or OAB were identified and observed to assess treatment and diagnostic patterns. Results Within the entire study sample (N = 462 400), BPH diagnosis (61.5%) and BPH treatment (73.7%) were more common than the corresponding values for OAB (25.8% and 7.0%, respectively). Notably, among diagnosed individuals, the dispensation of a corresponding treatment was more likely in individuals diagnosed with BPH (183 672 out of 284 416 = 64.6%) compared with OAB (16 468 out of 119 236 = 13.8%). Among newly diagnosed and/or treated patients (n = 196 576), only 60.3% received treatment. Among treated patients, most experienced only a single type of treatment (93.4%), 6.6% went on to receive a secondary treatment and 3.5% a tertiary. The most common primary treatment was alpha‐blocker monotherapy (76.9%) followed by tadalafil monotherapy (16.4%). Among those untreated at first diagnosis, the median time between diagnosis and treatment initiation was 128 days. Conclusions Diagnosis and management of OAB among males are challenging given the inherent overlap in symptoms observed with BPH. Unsurprisingly, we found that BPH is diagnosed and treated more frequently than OAB; but the differences between diagnosis and treatment patterns for the two conditions highlight the potential undertreatment of OAB and misdirection of therapy for men with a combination of voiding and storage symptoms.