Cost effectiveness of Mirabegron and antimuscarinic drugs in patients with hiperactive bladder

Autores de IIS La Fe

• Salvador Arlandis Guzmán

  Autor

Participantes ajenos a IIS La Fe

• Brenes-Bermúdez F
• Jiménez-Cidre MA
• Rubio-Rodríguez D
• Rubio-Terrés C
• Mora AM
• Duran A

Grupos

• Urología

  Leader

  Francisco Boronat Tormo

Abstract

OBJECTIVE: To evaluate the cost-effectiveness of mirabegron in comparison to the antimuscarinic drugs tolterodine, solifenacin and fesoterodine, in the treatment of urgency, increased micturition frequency and urinary incontinence in patients with overactive bladder (OAB). MATERIAL AND METHODS: A Markov model in Excel, with a time horizon of 5 years was developed from the National Health System and societal perspective. Clinical effectiveness was estimated from a clinical trial (SCORPIO) and a network meta-analysis. Unit costs were obtained from Spanish sources. The effectiveness of the treatments was measured as quality adjusted life-years (QALY). Deterministic and probabilistic sensitivity analyses were performed. RESULTS: For the 5-year time horizon, the incremental cost per patient with mirabegron 50 mg versus tolterodine was (sic) 195.52 and (sic) 157.42, from the National Health System (NHS) and societal perspectives respectively, with a gain of 0.0127 QALY with mirabegron. Consequently, the cost of gaining a QALY with mirabegron versus tolterodine was 15,432 (sic) and 12,425 (sic) respectively. The probability that mirabegron would be cost-effective at a willingness to pay threshold of (sic) 30,000 was: 70% (NHS) and 71% (society) versus tolterodine; 94% (NHS and society) versus solifenacin 5 mg; 84% (NHS) and 84.5% (society) versus solifenacin 10 mg; 96% (NHS and society) versus fesoterodine 4 mg; 98% (NHS) and 99% (society) versus fesoterodine 8 mg. The highest probability that mirabegron would be cost-effective at a willingness to pay threshold of (sic) 20.000 and (sic) 25.000 per QALY gained, is obtained versus fesoterodine 4 mg and 8 mg from both NHS and society perspectives. CONCLUSIONS: The treatment of patients with OAB with mirabegron 50 mg is likely to be cost-effective compared to treatment with antimuscarinics.

Keywords

• Mirabegron; Antimuscarinic; Tolterodine; Solifenacin; Fesoterodine; Overactive bladder; Cost-effectiveness