Contemporary clinical guidance for Overactive bladder (OAB) has shifted away from rigid stepwise treatment escalation toward more individualized, patient centered decision making, allowing earlier consideration of minimally invasive therapies (MIT) when appropriate. However, evidence on how the timing of MIT initiation influences real world healthcare patterns and outcomes remains limited. This study evaluated differences in OAB related healthcare utilization and medication use prior to MIT initiation by MIT timing as a proxy for pre treatment care burden and examined whether earlier initiation of MIT following OAB diagnosis is associated with changes in subsequent healthcare utilization, costs, and complication risk in an older adult population.

This retrospective cohort study used medical and pharmacy claims data from Medicare fee for service beneficiaries in the United States. Patients with an initial OAB diagnosis between 2018 and 2022 who initiated MIT (sacral neuromodulation, percutaneous tibial nerve stimulation, and intradetrusor botulinum toxin injection) in 2022 were included. Patients were classified based on the interval between first OAB diagnosis and MIT initiation as early initiation (≤12 months) or late initiation (>12 months) group. During the pre treatment period, OAB related healthcare utilization, medication use, and medication associated adverse events were compared between the two groups. To assess post treatment outcomes, early and late groups were matched 1:1 using propensity scores derived from baseline demographic and clinical characteristics. Outcomes during the two years following MIT initiation included annualized all cause and OAB related healthcare costs and selected OAB complications. Generalized linear mixed models were used to estimate adjusted cost differences, and risk comparisons were conducted for complication outcomes.

Among 27,088 patients initiating MIT, 27.3% received SNM, 26.0% PTNS, and 46.7% Botox®. Mean time to MIT was 141 days among those initiated within 12 months of OAB diagnosis (early, n=6,162) vs 1,364 days among those initiated after 12 months (late, n=20,926). Both groups were 78% female. Baseline differences before MIT in the early vs late group respectively included age (73.8y vs 75.6y), race (89% vs 90% White), region (26% vs 22% West), and Charlson Comorbidity Index (CCI 2.55 vs 2.77), all significant (p<0.001). Prior to MIT initiation, patients in the late initiation group had higher OAB related healthcare costs, greater exposure to OAB medications, and a higher burden of medication associated adverse events compared with early initiation group. After propensity score matching (6,162 patients per group), baseline demographic and clinical characteristics were well balanced. During the two year post initiation period, early MIT initiation was associated with 9% lower annualized OAB related healthcare costs compared with late initiation (US $4,618 vs $5,083; p<0.001). Early initiation was also associated with a lower risk of depression or anxiety (21.7% vs 23.7%; p=0.0132) and a substantially lower risk of urinary tract infection (41.0% vs 48.8%; p<0.001).

Patients who delayed MIT accumulated greater treatment burden prior to intervention, while earlier MIT initiation was associated with lower post-treatment OAB costs and complications, and with reduced risk of depression and anxiety, and risk of urinary tract infection.

These findings support individualized treatment pathways that consider timely use of minimally invasive therapies based on patient needs and preferences.

Continence 19S (2026) 102478
DOI: 10.1016/j.cont.2026.102478