Treatment Crossover Following Advanced Therapy for Overactive Bladder Syndrome

Importance Patients deciding between advanced therapies for overactive bladder syndrome may be interested to know the likelihood of treatment crossover after sacral neuromodulation, intradetrusor OnabotulinumtoxinA, or percutaneous tibial nerve stimulation. Treatment crossover was defined as a switch from one advanced therapy to another. Objectives The aim of this study was to estimate the rate of treatment crossover after each advanced therapy for nonneurogenic overactive bladder syndrome. Our secondary objective was to compare medication use after each advanced therapy. Study Design Using claims data from the MarketScan database, privately insured women 18–65 years old with overactive bladder syndrome were identified for this retrospective cohort study. For all patients who received an advanced therapy between 2013 and 2019, we calculated the proportion who subsequently crossed over to a different advanced treatment. For each advanced therapy, we also calculated the proportion who subsequently utilized overactive bladder medication. Results We identified 7,231 adult women who underwent index advanced therapy for overactive bladder syndrome between 2013 and 2019. Treatment crossover occurred in 309 women (4.3%) and was significantly more likely following percutaneous tibial nerve stimulation (8.0%) compared to sacral neuromodulation (4.2%) or intradetrusor OnabotulinumtoxinA (2.6%, P < 0.01). Treatment crossover was also more likely following sacral neuromodulation compared to intradetrusor OnabotulinumtoxinA (P < 0.01). Medication use after advanced therapy was more common after percutaneous tibial nerve stimulation (29.2%) compared to intradetrusor OnabotulinumtoxinA (20.4%) or sacral neuromodulation (18.8%, P < 0.01). Conclusions Treatment crossover following advanced therapy for overactive bladder syndrome was uncommon but was significantly more likely after percutaneous tibial nerve stimulation. Medication use following advanced treatment occurred in a substantial minority in all cohorts.