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MP69-02: Variation in Care Intensity for Overactive Bladder Symptoms Among Medicare Beneficiaries

Monday, May 15
7:00 AM - 9:00 AM
Location: BCEC: Room 153

Presentation Authors: Charles Scales Jr*, Melissa Greiner, Lesley Curtis, Brad Hammill, Andrew Peterson, Cindy Amundsen, Kenneth Schmader, Durham, NC

Introduction: Overactive bladder (OAB) affects up to 40-50% of older men and women. OAB diminishes quality of life through its impact on daily living and emotional well-being, even in the absence of urine loss. The economic costs of treating patients with OAB are projected to exceed $80 billion annually by 2020, more than half incurred by Medicare beneficiaries. Our objective was to describe variation in downstream care intensity after initial treatment of OAB symptoms among Medicare Part D beneficiaries.

Methods: We performed a retrospective cohort study of beneficiaries using the Medicare 5% sample. Between 2007-2013, we identified beneficiaries with an outpatient encounter consistent with OAB symptoms and a Medicare Part D drug claim for pharmacotherapy. Subjects with urinary tract infection within 30 days, neurogenic bladder, and prostate cancer diagnoses were excluded. No subject had a prior OAB drug claim. We followed beneficiaries for two years after initial treatment. We used OAB-specific expenditures as a proxy for care intensity. Using a multivariable Poisson regression model with a log link, we identified associations between patient and provider characteristics and downstream OAB Medicare costs. All expenditures were inflation-adjusted to 2013 dollars.

Results: During the study period, 5,337 beneficiaries had an initial drug claim and 2 years of continuous follow up. The average beneficiary was aged 78 ± 7.1 years, 80% were female, and 89% were white. In multivariable models, expenditures for Medicaid-eligible beneficiaries were 35% higher (95% CI 20-52%, p<0.001). Expenditures for individuals initially treated by urologists were 23% higher (95% CI, 11-37%, p<0.001) than those initially treated by primary care, even after controlling for urinary incontinence. Urodynamic evaluation was much more likely under the treatment of urology or gynecology specialists. Once individuals initiated treatment with a given specialty (e.g., gynecology), the vast majority continued treatment within that specialty, rather than returning to primary care.

Conclusions: Downstream OAB treatment costs vary by both patient and provider characteristics, and particularly by provider specialty, even after controlling for the presence of incontinence. Individuals are unlikely to change between specialties once treatment is initiated. To the extent that these data represent unwarranted variation in care intensity, an opportunity to improve efficiency and value of care may exist.

Source Of Funding: NIH/NIA GEMSSTAR program (R03AG048130) and American Geriatric Society Dennis W. Jahnigen Career Development Award (Scales).

Charles D. Scales, MD, MSHS

Duke University School of Medicine

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