Disparities in the Use of Chemodenervation for Overactive Bladder

Objectives: To examine whether race/ethnicity is significantly associated with the administration of chemodenervation with onabotulinumtoxinA to treat overactive bladder (OAB) among female Medicare beneficiaries.

Methods: This was a retrospective cohort study of female Medicare beneficiaries aged 65 or older who received a new diagnosis of OAB from 2012 to 2020. The Center for Medicare and Medicaid Services 5% Limited Data Set (LDS) was queried to identify subjects meeting inclusion criteria. A new OAB diagnosis was defined as the first use of an ICD code for OAB at a clinical encounter after at least one year of continuous Medicare enrollment. Subjects were excluded if they had a diagnosis of neurogenic bladder or a contraindication to receiving onabotulinumtoxinA, including a diagnosis of Myasthenia Gravis or Lambert Eaton Syndrome. Race/ethnicity categories were derived based on definitions used within the LDS. The cumulative incidence of subjects who received intradetrusor chemodenervation within 5 years of their OAB diagnosis was compared between racial and ethnic groups. Survival analysis was performed to determine predictors for likelihood of treatment with chemodenervation and adjust for potential confounders.

Results: 232,366 females with a new diagnosis of OAB/UUI were identified (Table 1). The cohort was 89% White, 5.8% Black, 1.5% Asian, 1.4% Hispanic, and 0.4% North American Native. 1.0% were listed as ‘Other’ race, and 0.7% had unknown race. Cumulative incidence of receiving intradetrusor chemodenervation within 5 years of OAB diagnosis was 1.4%, with lower rates noted among Black (0.7%), Asian (0.6%), Hispanic (0.7%), and Other race groups (0.9%) (p < 0.001). The number of North American Native females receiving chemodenervation was too small to report. After adjustments, age (aHR 0.97, 95% CI 0.96-0.97), dual Medicare/Medicaid eligibility status (aHR 0.60, 95% CI 0.52-0.70), rural location (aHR 0.77, 95% CI 0.70-0.85), region (Northeast: aHR 0.85, 95% CI 0.77-0.95; West: aHR 1.18, 95% CI 1.06-1.31), and non-White race or ethnic groups (Black: aHR 0.56, 95% CI 0.45-0.69; Asian: aHR 0.51, 95% CI 0.33-0.80; Other: aHR 0.58, 95% CI 0.37-0.91; Hispanic: aHR 0.62, 95% CI 0.40-0.96) were found to be associated with significantly lower relative hazard of receiving intradetrusor chemodenervation as treatment for OAB at 5 years after initial OAB diagnosis (Table 2).

Conclusions: Overall utilization of chemodenervation for OAB treatment was low in this national cohort of older women. Racial and ethnic disparities in use of chemodenervation highlight potential access issues. Further research is needed to understand the barriers these groups face in accessing this effective OAB treatment, as well as to evaluate potential interventions to reduce barriers to care.