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Patient preferences for treating refractory overactive bladder in the UK

  • Urology - Original article
  • Published:
International Urology and Nephrology Aims and scope Submit manuscript

Abstract

Objective

To evaluate patient preferences for refractory overactive bladder (OAB) treatments: sacral neuromodulation (SNM), onabotulinum toxin A (Botox®), and percutaneous tibial nerve stimulation (PTNS).

Materials and methods

A cross-sectional Web survey was conducted with UK idiopathic OAB patients, recruited by a market research company. Preference was explored using direct questioning, comparing SNM, Botox, and PTNS, and via best–worst scaling (BWS). In BWS, patients prioritized subsets of 13 treatment characteristics (attributes) across 13 choice tasks, identifying the attribute they considered best and worst in each task. The attributes were those that were identified by patients in previous qualitative interviews as influential in treatment selection. BWS scores for each attribute, ranging from 1.0 (most favourable) to −1.0 (most unfavourable), were calculated based on the rates they were identified as best and as worst. To identify attributes that may influence treatment choice, BWS scores were compared among patients based on their most preferred treatment using analyses of variance; pairwise differences were assessed using Tukey’s multiple comparisons test.

Results

The study population (N = 139) was 77 % female, had a mean age of 49 years, and were diagnosed a mean of 6.1 years ago. All 13 attribute BWS scores were viewed positively (score > 0.0) or negatively (score < 0.0). Among the 127 (91 %) of patients who had experience with OAB medication only, most (≥80 %) were willing to try each of the three treatments; 57, 34, and 9 % most preferred PTNS, SNM, and Botox, respectively. Preferences for the attributes differed based on which treatment that patients preferred. Specifically, patients preferring SNM (PS) favoured ‘implanted device in upper buttock’ more than those preferring PTNS (PP) or Botox (PB). Compared to PB, PS also favoured ‘sends signals between bladder and brain to help restore bladder function’ and ‘test phase’. PB favoured ‘Botox (botulinum toxin) treatment’ and ‘treatment procedure delivered through the urethra’ more than PS and PP. PP favoured the following more than PS and PB: ‘needle inserted into ankle’, ‘minimal side effects’ and ‘treatment requires repeated visits over time’.

Conclusion

This study identified specific characteristics of specialized therapies for refractory OAB that may significantly influence patient preferences, which may be used to help inform treatment decision-making.

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Acknowledgments

The authors would like to thank Global Perspectives for their assistance with patient recruitment.

Funding

This study was funded by Medtronic (Minneapolis, MN). Medtronic manufactures equipment for sacral nerve stimulation, which is one of the treatment options studied.

Author information

Authors and Affiliations

  1. Bristol Urological Institute, Bristol, UK

    Hashim Hashim

  2. ORS Health, 3523 Albemarle St. NW, Washington, DC, 20008, USA

    Kathleen Beusterien

  3. Department of Health Policy and Management, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA

    John F. P. Bridges

  4. ORS Health, Andover, MA, USA

    Kaitlan Amos

  5. Urogynaecology Department, King’s College Hospital, London, UK

    Linda Cardozo

Authors
  1. Hashim Hashim
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  2. Kathleen Beusterien
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  3. John F. P. Bridges
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  4. Kaitlan Amos
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  5. Linda Cardozo
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Corresponding author

Correspondence to Kathleen Beusterien.

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Conflict of interest

Hashim Hashim has served as a Mentor for Medtronic and as a Speaker and Mentor for Allergan. Kathleen Beusterien is founder of ORS Health, which consults for Medtronic. Kaitlan Amos works for ORS Health, which provides consulting services to Medtronic. John Bridges declares that he has no conflict of interest. Linda Cardozo declares that she has no conflict of interest.

Ethical approval

All procedures performed were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki Declaration and its later amendments or comparable ethical standards. This study was approved by a commercial IRB that covers studies in the UK (Magil IRB; Rockville, MD).

Informed consent

Informed consent was obtained from all individual participants included in the study.

Additional information

Handling editor: Dr. Ananias C. Diokno.

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Hashim, H., Beusterien, K., Bridges, J.F.P. et al. Patient preferences for treating refractory overactive bladder in the UK. Int Urol Nephrol 47, 1619–1627 (2015). https://doi.org/10.1007/s11255-015-1100-3

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  • DOI: https://doi.org/10.1007/s11255-015-1100-3

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