Review of Economic Value Drivers of the Treatment of Overactive Bladder

Abstract

Overactive bladder (OAB) is a symptom-driven condition with economic burden estimated to be on the order of several hundred dollars or euros per patient in some North American and European countries. This work reviews recently published economic models to evaluate how health states are defined, what cost components are considered, and what utility values are used to estimate the cost effectiveness of OAB pharmacotherapies, botulinum toxin, or sacral neuromodulation. It was found that no clear standard exists for determining OAB health states, although most were defined by some measure of incontinence frequency. Costs of physician visits and incontinence pads were included in nearly all models; however, OAB-associated depression and nursing home costs were rarely included, despite being large cost drivers of global economic burden studies. Utility values used in the models ranged from 0.544 to 0.933, highlighting the uncertainty associated with how OAB patients value health-related quality of life. More research is warranted so that health states providing delineations among OAB symptom severity and quality of life are clinically and economically meaningful as well as meaningful to affected patients.

Comparative effectiveness of one versus two‐stage sacral neurostimulation device placement

“…Sacral nerve stimulation is an important and effective third‐line therapy in the treatment of overactive bladder symptoms. However, compared to other third‐line treatments, cost is a significant factor to consider with SNS . As such, efforts to help make this therapy more cost effective would increase its potential use for patients.…”

“…However, compared to other third-line treatments, cost is a significant factor to consider with SNS. 5,6 As such, efforts to help make this therapy more cost effective would increase its potential use for patients. In this study, we used current Medicare CPT code and APC coding to derive the national average costs for this procedure.…”

“…While the efficacy and success of SNS has been well described, the procedure is relatively costly. 5,6 Despite comparable efficacy to alternative third line treatment options, such a intravesical onabotulinumtoxinA injection, SNS does represent a more costly intervention, with complete implantation typically requiring two separate operative procedures. 7 Furthermore, rates of repeat intervention for device related issues and failures have been reported to occur in as many as one in three patients following permanent placement.…”

“…While the efficacy and success of SNS has been well described, the procedure is relatively costly . Despite comparable efficacy to alternative third line treatment options, such a intravesical onabotulinumtoxinA injection, SNS does represent a more costly intervention, with complete implantation typically requiring two separate operative procedures .…”

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

“…Our model structure is based on previously published cost-effectiveness models that have been reviewed and deemed acceptable [58]. A review of published economic models evaluating OAB pharmacotherapies found that no standard exists for defining OAB health states, although most include a measure of incontinence frequency like the current study [59]. Other strengths of our model include the quality of the SCORPIO trial data, the inclusion of utilities based on both OAB-5D and EQ-5D instruments, the inclusion of ACB as a factor in the analysis (as mirabegron does not share the ACB associated with antimuscarinic pharmacological OAB treatments), and finally the inclusion of the latest 2017 persistence data for oral OAB therapies [27].…”