Cost-effectiveness of mirabegron compared to tolterodine ER 4 mg for overactive bladder in Canada

Abstract

Introduction: This analysis compared the cost-effectiveness of once-daily regimens of mirabegron 50 mg and generic tolterodine ER 4 mg in a hypothetical cohort of previously treated patients with overactive bladder (OAB) in Canada. Methods: A Markov model was developed to represent different health states according to OAB symptoms (frequency, incontinence), presence/absence of adverse events (AEs; dry mouth, constipation, blurred vision), and treatment status (on-treatment, discontinue treatment, restart previous treatment). The time horizon used was one year, with monthly transitions between health states. The model was populated using data from a phase 3, placebo-controlled trial of mirabegron that included tolterodine as an active comparator (SCORPIO), as well as other published literature and expert opinion. Cost-effectiveness was calculated from Canadian public payer (based on Quebec list prices) and societal perspectives. Results: The incremental one-year cost per patient for mirabegron over tolterodine was $182 CAD and $157 CAD from the payer and societal perspectives, respectively. The incremental quality-adjusted life year (QALY) gain for mirabegron was 0.0066 when using EQ-5D health-state utilities. Mirabegron was cost-effective compared with tolterodine, from both payer and societal perspectives, and remained cost-effective vs. tolterodine across the majority of sensitivity analyses. The model was based on limited clinical trial evidence supplemented with expert opinion and assumptions; a select number of OAB symptoms, AEs, and direct and indirect medical costs associated with OAB; and a timeframe of only one year. Conclusions: From the payer and societal perspectives, the health economic model indicates that in Canada, mirabegron is a cost-effective treatment strategy compared with tolterodine, leading to improved health outcomes (QALYs) at an acceptable incremental cost. IntroductionOveractive bladder (OAB) is a bothersome condition with a relatively high prevalence in the general population. In a survey of over 16 500 subjects aged ≥40 years in six European countries, the prevalence of OAB was 16.6%.1 In a subsequent survey of over 19 000 subjects aged ≥18 years in Canada and Europe, the prevalence of OAB was 11.8%. OAB has a substantial negative impact on patients' health-related quality of life (HRQoL) and mental health. 5The cardinal symptoms -urgency with or without incontinence, usually associated with frequency, and nocturia 6 -interfere with basic activities of daily living, such as work, travel, sleep, interpersonal activities, sexual function, and physical activities. 7,8 Studies have often focused specifically on the impact of incontinence, but it has been shown that frequency and urgency, which are more prevalent, are as bothersome as urgency incontinence.1 In terms of mental health, it is estimated that approximately one-third of men and women with lower urinary tract symptoms may have comorbid clinical anxiety and/or depression. 9 In addition, it has been shown that the prevale...

Cost-Effectiveness Analysis and Budget Impact: Antimuscarinics and Mirabegron for the Treatment of Patients With Urge Urinary Incontinence: The Brazilian Public Health System Perspective

“…Instead, we used hard UI clinical outcomes to reflect the increase in clinical results. Generally speaking, the components of cost were the same between our study and other CEA studies and comprised drugs, pads, general practitioner, and outpatient visits, [40][41][42][43][44] According to a recent review, 45 early studies stated that OXY was the most cost-effective pharmacological option for overactive bladder. On the other hand, recent studies tended to establish SOL as the most cost-effective option.…”

“…Studies that applied QALY have estimated utility values based on national cohorts or on the health states of the EQ-5D, available in the SCORPIO trial. [40][41][42][43][44] However, the SCORPIO trial context is that for Europe and Australia. In addition, we do not have enough observational data available in Brazil, which could be used to estimate utility.…”

“…Studies published in the last 2 years do not suggest the same conclusion, nor did they apply the same methods or predefine modeling parameters. [46][47][48][49][50] In addition, these studies did not include the same pharmacological agents. Authors that considered the perspectives of health systems achieved different conclusions.…”

“…48 A Canadian study achieved the same conclusion. 49 A study from the United Kingdom applied the National Health System (NHS) perspective. This study concluded that 5 mg of SOL was more cost-effective than 10 mg of fesoterodine, OXY, TOL, and SOL.…”

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

“…It is based on a new Markov state-transition model [14,15], which was then adapted for the present study. Mirabegron, another pertinent comparator, has been considered in other previously reported analyses based on the same model [14,15,40]. Unlike previous models described above, this model had a longer time horizon of 5 years, included treatment switching and treatment restart, as well as considering the effects of AEs on persistence and utilities.…”