Treatment patterns in men prescribed benign prostatic obstruction or overactive bladder medications in Canada: a retrospective population-based study

To characterize first therapeutic change and healthcare resource utilization in older men initiating an overactive bladder or benign prostatic obstruction medication. A retrospective cohort study using health administrative data from ICES in Ontario, Canada (from 01-Apr-2010 to 31-Dec-2018) was conducted in men aged ≥66 years with ≥1 overactive bladder (β3 agonist, antimuscarinic) or benign prostatic obstruction (α-blocker, 5-α-reductase inhibitor) prescription and ≥1-year post-index data (index=first observed dispensation). Exclusions: prescriptions for these drugs ≤1 year pre-index, a related procedure ≤5 years. Patients were grouped by condition based on index prescription. Treatment changes in relation to overactive bladder and benign prostatic obstruction were characterized by type. Costs and healthcare resource utilization pre- and post-index were compared. Age, geographic region, and income were similar between groups. The most common initial treatments were antimuscarinics (78.1%) in the overactive bladder group and alpha-blockers (86.4%) in the benign prostatic obstruction group. The overactive bladder group was more likely to experience a therapeutic change and had a shorter time to first change in therapy (78 [30,231] vs. 104 [30,350] days) and higher mean healthcare costs both pre- ($12,354 vs $11,497) and post-index ($14,423 vs $12,852). The most common first therapeutic change in both groups was discontinuing treatment (overactive bladder: 75.6%; benign prostatic obstruction: 69.9%). Men initiating overactive bladder medications changed therapy sooner than those initiating benign prostatic obstruction medications. Most discontinued first-line therapy without initiating further treatment, suggesting unmet need in this population.