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Research Article
3 December 2025

Health outcomes and costs in patients prescribed anticholinergic medications for overactive bladder

Authors: Holly E Richter https://orcid.org/0000-0001-7741-5771 [email protected], Benjamin Chastek https://orcid.org/0000-0002-9759-6001, Adam Carrera https://orcid.org/0009-0006-6588-7468, Christina Steiger https://orcid.org/0000-0002-1246-1635, Daniel Snyder, Laleh Abedinzadeh https://orcid.org/0009-0004-7568-2787, Tim Bancroft https://orcid.org/0000-0002-4998-582X, Jeffrey Nesheim https://orcid.org/0000-0003-0805-5615, Roger R Dmochowski https://orcid.org/0000-0002-9838-9178, Adonis K Hijaz https://orcid.org/0000-0003-0911-682X, and Jeffrey Frankel https://orcid.org/0000-0002-0142-9015Author Info & Affiliations
Volume 15, Number 1
https://doi.org/10.57264/cer-2025-0054
PDFFormats

Abstract

Aim: Anticholinergic burden (ACB) is associated with profound clinical and economic burden; however, anticholinergic medications are often prescribed for overactive bladder (OAB). This analysis assessed risk of adverse health outcomes and costs associated with ACB among patients with OAB. Materials & methods: Adults with ≥1 pharmacy claim for ≥1 OAB anticholinergic medication and continuous coverage for ≥6 months before and after the first prescription fill date for OAB anticholinergic medication (index) from January 2010 to November 2021 in the Optum Research Database were included. Daily ACB scores were calculated postindex. The impact of ACB on risk of certain adverse health outcomes was examined using Cox proportional hazards regression with categorical and piecewise linear specifications for ACB. Time-varying total ACB association with healthcare costs was evaluated with marginal structural models. Results: Overall, 428,142 patients were included in the analysis; mean (SD) age was 65.2 (14.9) years. Mean (SD) preindex ACB was 0.53 (1.44) points/day. Postindex, OAB medications accounted for 61.0% (95% CI: 60.9%–61.1%) of total ACB. Adjusted hazard ratios for urinary tract infection (UTI), urinary retention, delirium/drowsiness, cognitive impairment, falls/fractures and cardiovascular events were >1 (vs 0 points/day) and increased with ACB. A 1-point/day increase in ACB was associated with increased risk of UTI, urinary retention, delirium/drowsiness, cognitive impairment, falls/fractures and cardiovascular events for patients with ACB ≤8 points/day preindex. Increasing ACB was associated with increased all-cause total healthcare costs and costs related to cognitive impairment and falls/fractures. Conclusion: The association between increased ACB and greater risk of certain adverse health outcomes and costs supports the reassessment of anticholinergic medication use for patients with OAB.

Plain language summary: what health outcomes & costs do patients taking anticholinergic medications for overactive bladder experience?

What is this article about?

This article answers the question of how does adding anticholinergic medication to a person’s current medication load, or increasing anticholinergic burden (ACB), affect the risk of adverse health outcomes and healthcare costs in patients with overactive bladder (OAB).

What were the results?

In this study of 428,142 patients with ≥1 pharmacy claim for ≥1 OAB anticholinergic medication, increasing ACB was strongly associated with greater risk of new-onset adverse health outcomes, including urinary tract infection, urinary retention, delirium/drowsiness, cognitive impairment, falls/fractures and cardiovascular events. Increasing ACB was also significantly associated with increased total healthcare costs, as well as costs related to cognitive impairment and falls or fractures.

What do the results mean?

These data support the reassessment of anticholinergic medication use for patients with OAB.

Shareable abstract

This retrospective longitudinal database analysis shows that anticholinergic burden is associated with greater risk of adverse health outcomes and costs and supports the reassessment of anticholinergic medication for people with overactive bladder.

Supplementary Material

File (supplemental materials.docx)
File (supplementary infographic.pdf)

References

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