Health outcomes and costs in patients prescribed anticholinergic medications for overactive bladder

Aim: Anticholinergic burden (ACB) is associated with profound clinical and economic burden; however, anticholinergic medications are often prescribed for overactive bladder (OAB). This analysis assessed risk of adverse health outcomes and costs associated with ACB among patients with OAB. Materials & methods: Adults with ≥1 pharmacy claim for ≥1 OAB anticholinergic medication and continuous coverage for ≥6 months before and after the first prescription fill date for OAB anticholinergic medication (index) from January 2010 to November 2021 in the Optum Research Database were included. Daily ACB scores were calculated postindex. The impact of ACB on risk of certain adverse health outcomes was examined using Cox proportional hazards regression with categorical and piecewise linear specifications for ACB. Time-varying total ACB association with healthcare costs was evaluated with marginal structural models. Results: Overall, 428,142 patients were included in the analysis; mean (SD) age was 65.2 (14.9) years. Mean (SD) preindex ACB was 0.53 (1.44) points/day. Postindex, OAB medications accounted for 61.0% (95% CI: 60.9%–61.1%) of total ACB. Adjusted hazard ratios for urinary tract infection (UTI), urinary retention, delirium/drowsiness, cognitive impairment, falls/fractures and cardiovascular events were >1 (vs 0 points/day) and increased with ACB. A 1-point/day increase in ACB was associated with increased risk of UTI, urinary retention, delirium/drowsiness, cognitive impairment, falls/fractures and cardiovascular events for patients with ACB ≤8 points/day preindex. Increasing ACB was associated with increased all-cause total healthcare costs and costs related to cognitive impairment and falls/fractures. Conclusion: The association between increased ACB and greater risk of certain adverse health outcomes and costs supports the reassessment of anticholinergic medication use for patients with OAB.