Cost-effectiveness analysis of antimuscarinics in the treatment of patients with overactive bladder in Spain: A decision-tree model

Abstract

BackgroundFesoterodine, a new once daily antimuscarinic, has proven to be an effective, safe, and well-tolerated treatment in patients with overactive bladder (OAB). To date, no analysis has evaluated the economic costs and benefits associated with fesoterodine, compared to antimuscarinics in Spain. The purpose of this analysis was to assess the economic value of OAB treatment with fesoterodine relative to extended release tolterodine and solifenacin, from the societal perspective.MethodsThe economic model was based on data from two 12-week, randomized, double-blind, and multicenter trials comparing fesoterodine and tolterodine extended released (ER). Treatment response rates for solifenacin were extracted from the published literature. Discontinuation and efficacy were based on the results of a 12-week multinational randomized clinical trial extrapolated to 52 weeks. Changes in health related quality of life were assessed with the King's Health Questionnaire, which was transformed into preference-based utility values. Medical costs included (expressed in € 2010) were antimuscarinics, physician visits, laboratory tests, incontinence pads and the costs of OAB-related comorbidities, fractures, skin infections, urinary tract infections, depression, and nursing home admissions associated with incontinence. Time lost from work was also considered. Univariate sensitivity analyses were also performed.ResultsAt week 12, continents accounted for 50.6%, 40.6% and 47.2% of patients in the fesoterodine, tolterodine, and solifenacin groups, respectively. By week 52, the projected proportions of patients remaining on therapy were 33.1%, 26.5% and 30.8%, respectively. The projected quality- adjusted life years (QALY) gain (compared to baseline) over the 52-week simulation period were 0.01014, 0.00846 and 0.00957, respectively. The overall treatment cost was estimated at €1,937, €2,089 and €1,960 for fesoterodine, tolterodine and solifenacin, respectively. Therefore, treatment with fesoterodine resulted in similar overall costs and greater QALY gain than treatment with either tolterodine or solifenacin. Sensitivity analysis showed that these results were robust to all changes performed.ConclusionsThe results of this economic analysis suggest that fesoterodine is a cost-effective alternative to tolterodine and solifenacin for the treatment of patients with OAB in Spain. Fesoterodine provides additional health benefits while maintain a similar level of costs being a cost-effective treatment strategy from a societal perspective.

Economic evaluation of pharmacological treatments for overactive bladder from the perspective of the UK National Health Service

“…Including lost-productivity costs may lead to further cost-savings associated with the new treatment sequence due to its improved disease control. In a previous cost-effectiveness study in OAB, results were consistent with the base case when productivity-related costs were excluded 36 . Several other limitations should be noted.…”

Bladder ultrasonography for diagnosing detrusor overactivity: test accuracy study and economic evaluation

“…A review of the Cost-Effectiveness Analysis Registry 167 using the terms 'overactive bladder', 'urinary incontinence' and 'detrusor overactivity' was performed to identify relevant utility weights for the outcomes experienced at a time point beyond the primary study end point. Eighteen studies [168][169][170][171][172][173][174][175][176][177][178][179][180][181][182][183][184][185][186] were identified and utility weights from one study 168 were selected to represent the QoL for subjective cure. This study was selected because the utility values were obtained with a sound theoretical approach (time trade-off) and were relevant to the symptoms of OAB and the type of interventions modelled.…”

Health related quality of life and productivity of women with overactive bladder

“…A KHQ kérdőívből egy algoritmus segítségével hasznosságérték is számolható, értéktartománya 0,787-0,996 [13]. A KHQ-ból szár-maztatott hasznosságértéket OAB-gyógyszerek egész-ség-gazdaságtani (költség/QALY) elemzésekben is alkalmazták [14,15]. Kutatásunkban elvégeztük a KHQ kérdőív eredményeinek hasznosságértékké transzformálását.…”

“…Költséghasznossági elemzésekben OAB-ban legtöbbször nem közvetlen EQ-5D-mérésen alapuló hasznosságértékkel számoltak, hanem egy specifi kus (a vizeletürítések gyakorisága, valamint az inkontinens epizódok számából képzett) mé-rőszám és az EQ-5D index közötti korreláció alapján végeztek becslést a különböző OAB súlyossági állapo-tok hasznosságértékeire [19]. A KHQ kérdőívből kalkulált hasznosságértéket is több esetben alkalmazták [14,15]. Vizsgálatunkban azonban a betegek a KHQhasznosságérték tartományának felső sávjába kerül-tek, így érdemi különbségek nem mutathatók ki, ami megkérdőjelezi a módszer megfelelőségét [20].…”