Fall/Fracture-Related Healthcare Costs and Their Association with Cumulative Anticholinergic Burden in People with Overactive Bladder

Greta Lozano-Ortega, Carol R. Schermer, David R. Walker, Shelagh M. Szabo (), Basia Rogula, Alison M. Deighton, Katherine L. Gooch and Noll L. Campbell
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Greta Lozano-Ortega: Broadstreet Health Economics and Outcomes Research
Carol R. Schermer: Astellas Pharmaceutical Global Development Inc.
David R. Walker: Astellas Pharmaceutical Global Development Inc.
Shelagh M. Szabo: Broadstreet Health Economics and Outcomes Research
Basia Rogula: Broadstreet Health Economics and Outcomes Research
Alison M. Deighton: Broadstreet Health Economics and Outcomes Research
Katherine L. Gooch: Astellas Pharmaceutical Global Development Inc.
Noll L. Campbell: Purdue University

PharmacoEconomics - Open, 2021, vol. 5, issue 1, No 6, 45-55

Abstract: Abstract Background Falls/fractures are major causes of morbidity and mortality among older adults and the resulting health consequences generate a substantial economic burden. Risk factors are numerous and include overactive bladder (OAB) and anticholinergic use. Objectives We aimed to estimate the impact of falls/fractures on all-cause healthcare resource utilization and costs, according to levels of cumulative anticholinergic burden, among individuals with OAB. Methods Among a US cohort of adults with OAB (identified based on medical claims for OAB or OAB-specific medications), the frequency of resource utilization (outpatients visits, medication use, and hospitalizations) was examined according to level of anticholinergic burden. Anticholinergic burden was assessed cumulatively using a published measure, and categorized as no, low, medium, or high. Resource utilization prior to and after a fall/fracture was compared. Generalized linear models were used to examine overall and incremental changes in healthcare resource utilization and costs by fall/fracture status, and annual costs were predicted according to age, sex, fall/fracture status, and level of anticholinergic burden. Results The mean age of the OAB cohort (n = 154,432) was 56 years, 68% were female, and baseline mean anticholinergic burden was 266.7 (i.e. a medium level of burden); a fall/fracture was experienced by 9.9% of the cohort. All estimates of resource utilization were higher among those with higher levels of anticholinergic burden, regardless of fall/fracture status, and higher for all levels of anticholinergic burden after a fall/fracture. Among those with a fall/fracture, the highest predicted annual costs were observed among those aged 66–75 years with high anticholinergic burden (US$22,408 for males, US$22,752 for females). Conclusions Falls/fractures were associated with higher costs, which increased with increasing anticholinergic burden.

Date: 2021
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DOI: 10.1007/s41669-020-00215-w

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