Overactive bladder symptoms adversely impact the mental health, work productivity, and sleep of affected individuals. There are many treatments for overactive bladder, with a range of routes of administration from oral and patch to bladder injections, and they have varying efficacy, safety and tolerability profiles. These risks and benefits factor into patients’ treatment decisions. The objective of this study was to identify which treatment attributes are considered important by pharmacotherapy-naïve patients with overactive bladder.

Patient preferences for overactive bladder treatment attributes were explored using a discrete choice experiment. The treatment attributes tested were identified through literature review, input from clinical experts and four patients with a self-reported physician diagnosis of overactive bladder, the latter among whom, the survey was piloted. Ten treatment attributes were selected, describing route of administration, efficacy, side effects, and out-of-pocket costs (Table 1). Respondents were sampled from a large online panel of patients, designed to be demographically representative of the United States general population. To be eligible, respondents had to be ≥18 years of age, diagnosed with overactive bladder by a physician or have self-reported symptoms of at least mild overactive bladder using the criteria set forth by Hall et al.(1) (i.e., defined by urinary daytime frequency, urgency, and incontinence), and be naïve to pharmacotherapy or invasive overactive bladder treatments. A hierarchical Bayesian random-effects-only model was used to estimate relative preference weights and relative importance scores of treatment attributes. If all attributes were deemed equally important by respondents, all relative importance scores would be equal to ten; a score of ten or above indicates higher importance. Multivariable linear regression with backward selection models were used to analyze differences in relative importance scores by demographic characteristics and disease burden-related metrics.

A total of 514 respondents completed the online survey. Most respondents were <65 years of age (66.0%) and female (68.5%). While many reported having moderate/severe overactive bladder symptoms (64.2%), only 35.8% of respondents had been formally diagnosed with overactive bladder by a physician, with the remaining 64.2% of respondents having self-reported overactive bladder. In selecting treatment, relative importance of the top three most important attributes in rank order were route of administration (18.8; standard deviation: 8.5), with patients having less preference for injectable therapies; improved efficacy defined as daytime micturition frequency (11.9; standard deviation: 4.5); and lower out-of-pocket cost (11.3; standard deviation: 7.6). Results of multivariable linear regression analyses indicated that females were less likely to prefer injectables, symptom control of incontinence was most important to respondents who reported greater work productivity loss, and out-of-pocket cost was most important to respondents with moderate/severe overactive bladder.

In a pharmacotherapy-naïve overactive bladder population, the route of administration followed by effect on daytime micturition frequency and patient out-of-pocket cost, were the most important treatment attributes.

A better understanding of patient treatment preferences for overactive bladder treatments will help inform patient centric decision making.

Hall SA, Link CL, Hu JC, Eggers PW, McKinlay JB. Drug treatment of urological symptoms: estimating the magnitude of unmet need in a community-based sample. BJU Int. 2009;104(11):1680-1688. doi:10.1111/j.1464-410X.2009.08686.x.