Treatment patterns in men prescribed benign prostatic obstruction or overactive bladder medications: A Canadian, retrospective, population-based study
Sender Herschorn1, Sarah Neu1, Rano Matta2, Jennifer A. Locke1, Rodrigo Martins de Almeida3, Lora Todorova3, Matthias Stoelzel4, Patrick Covernton3.
1Sunnybrook Health Sciences Centre, University of Toronto, Toronto, ON, Canada; 2Division of Urology, University of Utah, Salt Lake City, UT, United States; 3Astellas Pharma Europe, Woking, United Kingdom; 4Astellas Pharma Europe B.V., Leiden, Netherlands
Introduction: Lower urinary tract symptoms include voiding, often indicative of benign prostatic obstruction (BPO), and storage symptoms, potentially indicative of overactive bladder (OAB). This study aimed to describe real-world treatment patterns for BPO and OAB in Canadian men and identify gaps in their treatment.
Methods: This population-based, retrospective cohort study was completed using linked health administrative databases in Ontario, Canada. From 2010–2018, males aged ≥66 years with ≥1 prescription for an OAB or BPO medication were included. The primary objective was to determine time from initiation of OAB/BPO treatment to change in therapy (time-to-event analysis). A secondary objective was to compare healthcare costs between both groups.
Results: Age at index, geographic region, and income were similar between groups (OAB: n=9229 [5.8%]; BPO: 151 055 [94.2%]). Median (interquartile range [IQR]) followup was: OAB 1480 (873–2310); BPO 1622 (932–2475) days. The most common first-line OAB medication class was antimuscarinics (78.1%; second-line: alpha-blockers, 63.1%); for BPO, first-line alpha-blockers were most common (90.8%; second-line: 5-alpha reductase inhibitors, 58.8%). Mean age at medication initiation in both groups was 75 years. Relative to the OAB group, men in the BPO group were less likely to experience a therapeutic change and had longer times to first change in therapy (OAB: median [IQR] days 78 [30, 231]; BPO: 104 [30, 350]) (Figure 1, Table 1). The most frequently observed first therapeutic change (Table 2) in both groups was treatment discontinuation (OAB: 75.6%; BPO: 69.9%). Mean healthcare costs were higher in the OAB vs. the BPO group, both in the pre- (OAB: $12 354 vs. BPO: $11 497) and post-index years (OAB: $14 423 vs. BPO: $12 852).
Conclusions: In this population, men initiating OAB medications changed therapy sooner compared to those starting BPO medications. In both groups, discontinuation was the most common change in therapy.
