Cost Effectiveness of Mirabegron Compared with Antimuscarinic Agents for the Treatment of Adults with Overactive Bladder in Colombia

Abstract

Objectives The aim of this study was to evaluate the cost effectiveness of mirabegron relative to two antimuscarinics, oxybutynin extended release (ER) and tolterodine ER, in patients with overactive bladder (OAB) from the perspective of a third-party payer in Colombia. Methods A Markov model simulated the therapeutic management, disease course, and complications in hypothetical cohorts of OAB patients over a 5-year period. The model predicted costs and three outcomes: quality-adjusted life-years (QALYs), micturition state improvement (MSI), and incontinence state improvement (ISI). In each 1-month cycle, patients could transition between different health states reflecting symptom severity. Transition probabilities were estimated from a published mirabegron trial and mixed treatment comparison. Other inputs such as treatment discontinuation based on treatment-specific rates of persistence, resource use and costs, anticholinergic burden, comorbidity treatment, and drug acquisition were obtained from Società Italiana Scienze Mediche, Instituto de Seguros Sociales Tariff Manual, published literature, and expert opinion. Deterministic and probabilistic sensitivity analyses were conducted. Costs are presented in 2017 Colombia Pesos (COP). Results Mirabegron was cost effective for all outcome measures at a willingness-to-pay threshold of 124,919,725 COP, which is three times the per capita gross domestic product (GDP). Using QALYs as the measure of effect, mirabegron had an incremental cost-effectiveness ratio (ICER) of 85,802,036 COP/QALY (26,365 USD/QALY) and 66,360,134 COP/ QALY (20,384 USD/QALY) versus oxybutynin and tolterodine, respectively. Probabilistic sensitivity analyses showed that mirabegron was cost effective in 99.5% and 100% of simulations compared with oxybutynin and tolterodine, respectively. Using MSI and ISI as the measure of effects yielded ICERs below one GDP. Conclusions Mirabegron is a cost effective alternative to oxybutynin and tolterodine from the perspective of a third-party payer in Colombia.

Overactive bladder medication prescription trends from 2014 to 2018

“…Studies demonstrate across numerous countries that mirabegron is cost effective compared to various anticholinergic therapies. Therefore, it is important to continue to monitor cost of mirabegron, as our study appears to demonstrate an increase over time in this US dataset 22–25 . Furthermore, introduction of industry sponsored events pertaining to OAB are prevalent internationally 26 .…”

“…Therefore, it is important to continue to monitor cost of mirabegron, as our study appears to demonstrate an increase over time in this US dataset. [22][23][24][25] Furthermore, introduction of industry sponsored events pertaining to OAB are prevalent internationally. 26 Marketing and pharmaceutical company promotion of newer products may play into prescribing patterns, although our study is unable to investigate this further.…”

EQ-5D-5L Population Norms and Health Inequality in Colombia

“…20 Another cost per QALY study of Colombian patients with overactive bladder used EQ-5D-3L states reported by Colombian patients using index values from another multicountry study. 21 EQ-5D-5L has been applied in a study of hemodialysis patients in Medellín using the levels on EQ-5D-5L values, but no index or EQ VAS values. 22 EQ-5D-5L has also been used with index values to investigate the health status of Colombian patients with HIV.…”

Budget Impact Analysis of Vibegron for the Treatment of Overactive Bladder in the USA

“…Model inputs used treatment differences versus placebo and assumed that patients reverted to their baseline disease severity after discontinuing treatment, therefore representing a conservative approach. Because anticholinergics for the treatment of OAB contribute to ACB, the BIM incorporated the real-world impact of ACB, which was modeled via increased HCRU (outpatient and emergency department visits), an approach used in other published OAB economic models [12,22,30]. The largest offsets upon addition of vibegron to the formulary were regarding ACB, owing to patients who may have previously received an anticholinergic for OAB now receiving vibegron, a β 3 -adrenergic agonist with no anticholinergic activity.…”