Effect of Potentially Inappropriate Use of Antimuscarinic Medications on Healthcare Use and Cost in Individuals with Overactive Bladder

• Autores: Brandon T. Suehs, Cralen Davis, Billy Franks, Thomas E. Yuran, Daniel Ng--, Jason Bradt, John Knispel, Maria Vassilakis, Todd Berner
• Localización: Journal of the American Geriatrics Society, ISSN 0002-8614, Vol. 64, Nº. 4, 2016, págs. 779-787
• Idioma: inglés
• Enlaces
  • Texto completo
• Resumen

  • Objectives To examine potentially inappropriate medication (PIM) use in older adults initiating an antimuscarinic medication for the treatment of overactive bladder (OAB).

    Design Retrospective database analysis.

    Setting Medical and pharmacy claims data.

    Participants Medicare Advantage Prescription Drug Plan members aged 65 and older newly initiated on an antimuscarinic OAB treatment were identified and assigned to PIM and non-PIM comparison groups based on 2012 American Geriatrics Society Beers Criteria and/or the presence of an anticholinergic medication interaction at the time of initiation of treatment (N = 66,275).

    Measurements Healthcare costs and OAB medication use.

    Results Of members initiated on an antimuscarinic OAB medication, 31.1% had a drug–drug or drug–disease or syndrome interaction. Dementia was the most common disease or syndrome interaction (11.3%), followed by constipation (8.6%) and delirium (2.9%). Paroxetine (2.6%), amitriptyline (2.2%), cyclobenzaprine (1.7%), and meclizine (1.6%) were the most common interacting medications. Subjects in the PIM group had greater healthcare costs over 12 months of follow-up ($12,001) than those in the non-PIM group ($9,373) after controlling for baseline characteristics (P < .001). There was no difference between the PIM and the non-PIM groups in odds of discontinuing OAB treatment at 12 months after controlling for baseline characteristics (odds ratio = 0.98, 95% confidence interval = 0.89–1.07, P = .63).

    Conclusion Potentially inappropriate medication use was highly prevalent and was associated with greater total healthcare costs. Providers should carefully consider medical history and concurrent medication use when initiating antimuscarinic medication for the treatment of OAB. Development of interventions to reduce potentially inappropriate use of antimuscarinics in individuals with OAB is warranted.