Trends in the utilization of minimally invasive therapies for overactive bladder among older adults: a national Medicare study.

OBJECTIVE: To examine population-based trends in utilization of minimally invasive therapies (MITs) for overactive bladder (OAB) stratified by age and frailty among Medicare beneficiaries. METHODS: This population-based study used a 20% sample of fee-for-service Medicare beneficiaries to investigate rates of utilization for MIT for OAB [onabotulinumtoxinA injections (BTX), percutaneous tibial nerve stimulation (PTNS), and sacral neuromodulation (SNM)] from 2015-2020. Adjusted incidence rates of each MIT were further stratified by age and frailty, measured by the Claims-based Frailty Index (CFI), using multivariable logistic regression. RESULTS: Among 5,944,458 beneficiaries, 39,211 (0.7%) underwent an MIT for OAB during the study period. Overall adjusted incidence increased from 141.2 per 100,000 in 2015 to 159.3 per 100,000 in 2019 (a 13% relative increase), driven largely by BTX (40% relative increase). Incidence decreased across all MITs in 2020. Among beneficiaries aged 66-84, greater levels of frailty were associated with higher use of all three therapies. However, this association was not observed in beneficiaries over age 85, where rates of use were uniformly low regardless of frailty status. CONCLUSIONS: Use of MITs for OAB increased from 2015-2019, mainly driven by increases in BTX. For all three types of MITs, greater levels of frailty were associated with increased utilization among beneficiaries <85 years, regardless of age, while rates for all 3 procedures were low regardless of frailty for beneficiaries ≥85, indicating that utilization of these procedures is driven more by age than frailty in the oldest age group. Further research is needed to determine the factors which influence MIT utilization rates.