Cost-effectiveness of solifenacin compared with oral antimuscarinic agents for the treatment of patients with overactive bladder in the UK

Costoefectividad del régimen combinado de mirabegron/solifenacina en el tratamiento del síndrome de vejiga hiperactiva en Colombia

Objetivo Evaluar la costoefectividad incremental del régimen combinado de mirabegron/solifenacina en comparación con el uso temprano de toxina botulínica, desde la perspectiva del sistema de salud colombiano, para el tratamiento de adultos con vejiga hiperactiva.

Métodos Se empleó un modelo de Markov en que se comparan dos secuencias de tratamiento, una con y otra sin mirabegron/solifenacina, para evaluar la costoefectividad en un horizonte temporal de cinco años. Debido a la perspectiva de análisis, sólo se tuvieron en cuenta los costos médicos directos. La eficacia del tratamiento evaluado y su comparador fue medida en términos de la reducción de episodios diarios de incontinencia y de la frecuencia de micciones. Los costos fueron expresados en pesos colombianos de 2019, y se aplicó una tasa de descuento de 5% tanto para desenlaces como para costos.

Resultados Para el caso base, el costo del tratamiento en la secuencia que incluye mirabegron/solifenacina fue mayor, pero generó un mayor número de años de vida ajustados por calidad, y así e obtuvo una razón de costoefectividad incremental de $13.637,184 si se considera el desenlace de reducción de episodios diarios de incontinencia de 50%, y de $29.313,848 si se considera el del 100%.

Conclusiones De acuerdo con los resultados de esta evaluación, para un horizonte de análisis de cinco años, la secuencia de tratamiento con mirabegron/solifenacina es una alternativa costoefectiva, si se considera un umbral de disposición a pagar de tres veces el producto interno bruto (PIB) per cápita.

Cost-Utility Analysis of Oxybutynin vs. OnabotulinumtoxinA (Botox) in the Treatment of Overactive Bladder Syndrome

Background: The UK National Health Service (NHS) propose the use of oxybutynin prior to onabotulinumtoxinA (Botox) in the management of overactive bladder syndrome (OAB). Oxybutynin is costly and associated with poor adherence, which may not occur with Botox. We conducted a cost-utility analysis (CUA) to compare the medications. Methods: we compared the two treatments in quality-adjusted life years (QALYS), through the NHS’s perspective. Costs were obtained from UK-based sources and were discounted. Total costs were determined by adding the treatment cost and management cost for complications on each branch. A 12-month time frame was used to model the data into a decision tree. Results: Our results found that using Botox first-line had greater cost utility than oxybutynin. The health net benefit calculation showed an increase in 0.22 QALYs when Botox was used first-line. Botox also had greater cost-effectiveness, with the exception of pediatric patients with an ICER of £42,272.14, which is above the NICE threshold of £30,000. Conclusion: Botox was found to be more cost-effective than antimuscarinics in the management of OAB in adults, however less cost-effective in younger patients. This predicates the need for further research to ascertain the age at which Botox becomes cost-effective in the management of OAB.

Italian real-life clinical setting: the persistence and adherence with mirabegron in women with overactive bladder

INTRODUCTION AND HYPOTHESIS

The aims of this study were to evaluate the persistence, the adherence on treatment with mirabegron, the reasons for the interruption in patients with overactive bladder syndrome (OAB) and their satisfaction.

METHODS

This was an Italian multicentre prospective study. Four tertiary urological centers were involved. We included women with no neurogenic OAB symptoms already in therapy with once-daily mirabegron 50 mg for 1 month. They were followed up at 1, 3 and 6 months post-treatment with uroflowmetry with voiding diary for 3 days and post-void residual measurement. They completed self-administered Overactive Bladder questionnaire short form (OABq), Morisky Medication Adherence Scale-4 short form (MMAS), Patient Global Impression-Improvement questionnaire. Patients were divided in OAB wet and OAB dry groups, and in treatment-naive and treatment-experienced groups.

RESULTS

Between January 2018 and July 2018, 80 patients with OAB were included. Fifteen (18.7%) patients continued the treatment for 6 months; 17.5% interrupted the therapy before 1 month: 30% within the third month, while, 33.7% after 1 month. The median time to discontinuation with mirabegron was 62.5 days. The mean adherence was 0.42 ± 0.33, median MMAS was 2 (0-4). The adherence was significantly greater in treatment-naïve (22.4%) than treatment-experienced (6.5%) patients, without statistically significant differences in the different OAB form. The cost is the main cause of interruption of therapy (50% of cases).There was an improvement of OABqSF score and PGI-I score.

CONCLUSION

In Italy, the cost compromises adherence and persistence of therapy with mirabegron despite the good functional outcomes.