Determining patient preferences in the treatment of medication‐refractory overactive bladder. Issue 2 (8th December 2022)

• Record Type: Journal Article
• Authors: Speed, Jacqueline; Welk, Blayne; Comiter, Craig; Elliott, Christopher
• Is Part Of: Neurourology and urodynamics. Volume 42:Issue 2(2023)
• Page Start: 419
• Page End: 426
• Publication Date: 2022-12-08
• Subjects: conjoint analysis -- overactive bladder -- patient decision‐making -- third‐line therapies; Urinary organs -- Periodicals; Urodynamics -- Periodicals; Urology -- Periodicals; 616.6
• DOI: 10.1002/nau.25109
• Languages: English
• ISSNs: 0733-2467

Abstract

Abstract: Introduction: Overactive bladder (OAB) is often suboptimally addressed by behavioral or pharmacological treatments. Less than 15% of patients choose to pursue advanced OAB therapy (sacral nerve stimulation [SNS], percutaneous tibial nerve stimulation [PTNS], and bladder onabotulinum toxin type‐A [BTX‐A]). We seek to better understand which factors are most important to patients when choosing a third‐line therapy. Methods/Materials: We developed a conjoint analysis survey that included five attributes of the third‐line options for OAB (SNS, PTNS, and BTX‐A). We administered the survey to new patients with urinary incontinence at two institutions. A hierarchical Bayes random effects regression analysis was used to determine the relative importance of the attributes. A choice simulator was used to model which third‐line treatment options patients preferred. We followed patients to see if they pursued their predicted treatment. Results: A total of 108 patients completed the study of whom 89% were women. There was representation from all age groups. The most important attributes of decision‐making were the frequency of future procedures, the risk of catheterization, and the need for a device. On market simulation, SNS was the preferred treatment option (47%), followed by PTNS (29%) and BTX‐A (14%). Only 10% of patients did not find any treatment option acceptable. Conclusions: Frequent follow‐up, risk of catheterization, and the need for a device were the most important attributes when making a decision on third‐line OAB therapy. On market simulation, SNS is the preferred treatment for all age groups though the ultimate choice in third‐line therapy may be affected by external factors.