Shifts in Patient Preference of Third-Line Overactive Bladder Therapy After Introduction of the Implantable Tibial Nerve Stimulator

Introduction and Objective
Third line therapies for overactive bladder (OAB) previously included intravesical Onabotulinumtoxin-A injections (BTX-A), percutaneous tibial nerve stimulation (PTNS), and sacral neuromodulation (SNM). The implantable tibial nerve stimulator (ITNS) is a novel therapy that is now available to eligible patients in this category. The objective of this study was to analyze shifts in patient preference of third line therapies for OAB after introducing ITNS as an option.

Methods
A voluntary survey was designed using SurveyMonkey and distributed amongst the platform’s targeted audience that included U.S. women ages 18-99. Screening questions were asked to include patients who expressed having symptoms of OAB. Pictorial and text descriptions of BTX-A, PTNS, and SNM were provided, and participants were asked to rank these 3 therapies in order of preference (stage A). Next, ITNS was introduced with a description and participants were asked to rank their preferences amongst of all 4 therapies (stage B). Changes in therapy preference were compared between stage A and stage B. SPSS software was used for data analysis.

Results
This sample (N = 303) was self-identified female (100%) and had a mean age of 49.7 +/- 4.5 years. The racial composition of our sample was 73% Caucasian, 6% African American, 6% Asian, 12% Hispanic, and 3% Other. In stage A, participants ranked their first choice of third line therapy as follows: 27% BTX-A, 25% PTNS, 13% SNM. 30% chose no therapy and 5% chose all three equally. In stage B, participants ranked their first choice as follows: 26% BTX-A, 18% PTNS, 6% SNM, 21.1% ITNS. 24% chose no therapy and 4% chose all four equally (Table 1).

Preference for BTX-A was minimally changed despite the introduction of TNS. There was a larger and absolute and relative decrease in proportion of patients interested in both PTNS and SNM after ITNS was introduced. The number of patients not interested in any therapy decreased between stage A and stage B, indicating that ITNS may have recruited a new subset of interested patients who previously did not consider SNM, PTNS, and BTX-A. Participants who chose ITNS were more likely to have been treated with PTNS and BTX-A (Table 2).

Conclusions
ITNS appears to compete with PTNS and SNM as an option for third line therapy for OAB. ITNS may not only detract from those who were previously interested in PTNS and SNM, but it may also attract patients who were not interested in any therapies prior to its debut. Further study is needed to characterize patients that will optimally benefit from this therapy and to increase its accessibility.