HOW COVID-19 HAS TRANSFORMED MY 3RD LINE OAB PENETRATION RATES

HOW COVID-19 HAS TRANSFORMED MY 3RD LINE OAB PENETRATION RATES

I aggressively use a constantly updated OAB Care Pathway to increase 3rd line penetration and intermittently analyze my ICD and CPT codes to monitor changes in therapy selection given new offerings in addition to evaluating the impact of unprecedented pandemic restrictions and telemedicine implementation. During the months prior to COVID, 40% of my Unique OAB patients obtained a 3rd line therapy with PTNS being the most popular which is not unexpected given my more holistic West Coast population. Nonetheless, Axonics was a major new offering introduced Nov 2019 with immediate strong traction PRE-COVID taking 100% SNM share after its approval with stable SNM selection at 11% amongst 3rd lines. During the 6-week acute COVID period (late March to early May), my 3rd line penetration dropped to 22% with inferior telemedicine visits, lack of medication sample trials, completely paused elective SNM surgery& minimal PTNS given social distancing compounded by furloughed staff. Botox office injections became the most pragmatic option and doubled from 31 to 65% of 3rd line share.

During this frustrating time, I attempted to reduce newly created COVID barriers with increased patient outreach and education. Specifically, I created the “Bladder Boutique” website to improve remote visits and also wrote an article for my clinic magazine which has a large distribution featuring information about advancements in SNM and SUI Bulking agents. With reopening in early May, I offered PNEs (85% Axonics vs. 15% MDT) when deemed appropriate for the first time in years to streamline the Axonics experience given initial constraints of 50% reduced OR time and need for tightly timed preop COVID testing. These efforts helped SNM rebound from 0% to 22% of 3rd line selection during the chronic COIVD phase (early May 2020 to early Feb 2021) which was double the PRE COVID SNM selection of 11%. PTNS made a partial recovery to 30% of 3rd line selection after reopening. I am encouraged that during the chronic COVID phase, my third line penetration rate recovered to 37% with Botox being the most selected (48% of 3rd lines) yet the gap in OAB treatment remains high. Although on track to recover in unique OAB patient visits (62 per month down from 80 per month Pre-COVID) despite the more recent largest and prolonged COVID surge, I am optimistic that a recent patient mailer on SNM evolution will improve awareness on possible relief of symptoms. I look forward to seeing what the data indicates within the OAB toolbox post pandemic.  

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