Percutaneous Tibial Nerve Stimulation or Percutaneous Tibial Neuromodulation (PTNM) is a therapy for Overactive Bladder (OAB) delivered over 12 consecutive weekly sessions. However, little is known about the application and adherence of this treatment in a real-world setting. This analysis aims to summarize patients’ time to complete treatment course and examine trends of two third-line therapy use--Sacral Neuromodulation (SNM) and onabotulinumtoxinA --during and after the treatment course.

Optum’s de-identified Clinformatics® Data Mart (CDM) Database and CMS Research Identifiable File (RIF) healthcare claims were queried for adults diagnosed with urgency, frequency and urge incontinence and underwent PTNM treatment during 2019—allowing for a 1-year follow-up period. Patients were required to have continuous enrollment and pharmacy coverage from 1-year prior to the initial PTNM treatment through the follow-up period. PTNM treatment within 30 days of a previous treatment was defined as part of the initial therapy. Compliance was defined as 12 PTNM-related visits. Primary outcomes were percentage of compliant PTNM-related visits within 1 year and total number of patients with SNM and onabotulinumtoxinA within the same year, segmented by 12-, 15-, 22-, and 52-week periods.

A total of 3,087 patients were included from CDM and 9,727 patients from RIF data. Completion of the initial treatment (12 treatments) increased over time from 16% at week 12 to 42% by week 52 and 24% to 38% for CDM and RIF data, respectively (Fig 1; both p<0.001). Similarly, utilization of third-line therapy increased over time and was higher for non-compliant patients: 0.2% of compliant and 0.8% of non-compliant CDM patients used onabotulinumtoxinA within 12 weeks (p=0.074). 0.6% of non-compliant RIF patients used onabotulinumtoxinA within 12 weeks while the volume of compliant RIF patients is too low to report. However, 4.9% of CDM compliant patients and 6.4% non-compliant used onabotulinumtoxinA within 52 weeks from the initial PTNM treatment; (p=0.035).  6.5% of non-compliant RIF patients and 5.7% of compliant patients used onabotulinumtoxinA within 52 weeks; (p=0.066). Similarly, SNM implant rates within 12 weeks were <1% for CDM and RIF patients. Within 52 weeks, SNM implant rates for CDM patients were 1.2% for compliant patients and 2.6% for non-compliant patients; (p= 0.002) and for RIF patients, 1.7% for compliant patients and 2.4% for non-compliant patients; (p=0.010).

Most patients are not compliant with the recommended treatment regimen of 12 PTNM treatments in 12 weeks. Patients non-compliant with the PTNM treatment regimen were more likely to pursue third-line treatment options.

The effectiveness of PTNM therapy for patients with OAB symptoms may be severely underestimated. This is valuable in consideration of implantable tibial technology.

Continence 7S1 (2023) 100764
DOI: 10.1016/j.cont.2023.100764