Percutaneous Tibial Neuromodulation Initial Therapy Compliance and Subsequent Third-Line Treatment Patterns

Document Type

Conference Proceeding

Publication Date


Publication Title

Journal of Urology


INTRODUCTION AND OBJECTIVE: 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 third-line therapy use–Sacral Neuromodulation (SNM) and Botox–during and after the treatment course. METHODS: Optum's 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. 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 Botox within the same year, segmented by 12-, 15-, 22-, and 52-week periods. RESULTS: 3,087 patients were included from CDM and 9,727patients from RIF data. Completion of initial treatment (12 treatments) increased over time; 16% at week 12 to 42% by week 52 and 24% to38% for CDM and RIF data, respectively (Figure 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 Botox within 12 weeks. However,4.9% of compliant and 6.4% of non-compliant CDM patients used Botox within 52 weeks; p[0.035. Similarly, SNM implant within12 weeks was<1% for CDM patients, and within 52 weeks were1.2% of compliant and 2.6% of non-compliant patients; p[0.002. Patients in the RIF data followed similar trends. CONCLUSIONS: Most patients are not compliant with the recommended treatment regimen of 12 PTNM treatments in 12 weeks. Non-compliant patients were more likely to pursue third-line treatment options. Signaling the effectiveness of PTNM therapy for patients with OAB symptoms may be severely underestimated. This is valuable in consideration of implantable tibial technology.





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American Urological Association Annual Meeting, April 28 - May 1, 2023, Chicago, IL