Despite Recommendations, Anticholinergics Account for the Majority of Prescriptions to Treat Overactive Bladder in the United States

Importance There are significant associations between anticholinergic medication use and an increased risk of cognitive impairment and dementia. Many experts now advocate minimizing the use of anticholinergic medications to treat overactive bladder (OAB) in elderly women. Objective The aim of this study was to describe temporal and geographic trends in the pharmacologic treatment of OAB for patients 65 years or older across the United States. Study Design The U.S. Centers for Medicare & Medicaid Services publishes annual Medicare Provider Utilization and Payment Data. The data set includes the number of unique Part D beneficiaries 65 years or older with at least 1 claim for a drug and the number of 30-day fills dispensed. The database also includes the U.S. state and rural-urban commuting area designation of the prescriber. Results From 2013 to 2019, Medicare Part D beneficiaries 65 years or older received 47.7 million 30-day fills for the treatment of OAB. In 2013, anticholinergics represented 98% of the total 30-day fills (5.6 million) for OAB. The use of beta 3 agonists was nearly 24 times greater in 2019 than in 2013. Geographic variation in prescribing practices was evident. Conclusions The number of anticholinergics dispensed for the treatment of OAB remained relatively stable, and there was a substantial increase in the use of beta 3 agonists. Percentages of anticholinergics dispensed varied among states. More patients are being treated for OAB; however, anticholinergics comprised the majority of prescriptions for treatment in 2019.

Automated summary

There is a strong association between the use of anticholinergic medication and an increased risk of cognitive impairment and dementia. Experts suggest minimizing the use of anticholinergics for treating overactive bladder (OAB) in elderly women. This study examines the temporal and geographic trends in pharmacologic treatment of OAB for patients aged 65 and older in the United States.