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Cost effectiveness of mirabegron compared with tolterodine extended release for the treatment of adults with overactive bladder in the United Kingdom.

Aballéa S, Maman K, Thokagevistk K, Nazir J, Odeyemi IA, Hakimi Z, Garnham A, Toumi M - Clin Drug Investig (2015)

Bottom Line: The resulting incremental cost-effectiveness ratio (ICER) was £4,386/QALY gained.The probability of mirabegron 50 mg being cost effective relative to tolterodine ER 4 mg was 89.4 % at the same WTP threshold.Mirabegron 50 mg/day is likely to be cost effective compared with tolterodine ER 4 mg/day for adult patients with OAB from a UK NHS perspective.

View Article: PubMed Central - PubMed

Affiliation: Creativ-Ceutical SARL, 215, rue du Faubourg St-Honoré, 75008, Paris, France, sab@creativ-ceutical.com.

ABSTRACT

Background: Overactive bladder (OAB) is highly prevalent and is associated with considerable morbidity and reduced health-related quality of life. β3-adrenergic receptor (β3-AR) stimulation is a novel alternative to antimuscarinic therapy for OAB.

Objective: The objective of this analysis was to assess the cost effectiveness of the β3-AR agonist mirabegron relative to tolterodine extended release (ER) in patients with OAB from a UK National Health Service (NHS) perspective.

Methods: A Markov model was developed to simulate the management, course of disease, and effect of complications in OAB patients over a period of 5 years. Transition probabilities for symptom severity levels and probabilities of adverse events were estimated from the results of the randomised, double-blind SCORPIO trial in 1,987 patients with OAB. Other model inputs were derived from the literature and on assumptions based on clinical experience.

Results: Total 5-year costs per patient were £1,645.62 for mirabegron 50 mg/day and £1,607.75 for tolterodine ER 4 mg/day. Mirabegron was associated with a gain of 0.009 quality-adjusted life-years (QALYs) with an additional cost of £37.88. The resulting incremental cost-effectiveness ratio (ICER) was £4,386/QALY gained. In deterministic sensitivity analyses in the general OAB population and several subgroups, ICERs remained below the generally accepted willingness-to-pay (WTP) threshold of £20,000/QALY gained. The probability of mirabegron 50 mg being cost effective relative to tolterodine ER 4 mg was 89.4 % at the same WTP threshold.

Conclusions: Mirabegron 50 mg/day is likely to be cost effective compared with tolterodine ER 4 mg/day for adult patients with OAB from a UK NHS perspective.

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Related in: MedlinePlus

Markov treatment pathway. BTX botulinum toxin, ER extended release, OAB overactive bladder syndrome
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Related In: Results  -  Collection


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Fig1: Markov treatment pathway. BTX botulinum toxin, ER extended release, OAB overactive bladder syndrome

Mentions: The model was programmed to run in Microsoft Excel 2007 (Microsoft Corp., Redmond, WA, USA). The treatment pathway, based on the model described above, for the analysis is shown in Fig. 1. Transitions are shown in more detail in Supplementary Figure 1. The model simulated changes in symptoms (frequency of micturitions and incontinence episodes, for which the model was run in parallel) at monthly intervals (i.e. 60 cycles over 5 years). Every month, patients could remain on treatment (mirabegron or tolterodine), switch to a treatment with efficacy and price similar to solifenacin or discontinue (i.e. go to ‘no treatment’). A small proportion received botulinum toxin (BTX) after this next line of therapy (this transition was not allowed directly after mirabegron or tolterodine). The probabilities of switch and discontinuation were dependent on adverse events. Patients with adverse events could stay on treatment, but incurred a disutility. Patients who discontinued treatment could naturally improve and thereby transition to a lower severity category after 1 month, or could worsen or stay the same. These patients could also restart their previous treatment, could move to a new treatment, or remain off treatment. In the event of success on BTX, patients were assumed to move to the lowest level of severity and remain there until the end of the simulation.Fig. 1


Cost effectiveness of mirabegron compared with tolterodine extended release for the treatment of adults with overactive bladder in the United Kingdom.

Aballéa S, Maman K, Thokagevistk K, Nazir J, Odeyemi IA, Hakimi Z, Garnham A, Toumi M - Clin Drug Investig (2015)

Markov treatment pathway. BTX botulinum toxin, ER extended release, OAB overactive bladder syndrome
© Copyright Policy - OpenAccess
Related In: Results  -  Collection

Show All Figures
getmorefigures.php?uid=PMC4300413&req=5

Fig1: Markov treatment pathway. BTX botulinum toxin, ER extended release, OAB overactive bladder syndrome
Mentions: The model was programmed to run in Microsoft Excel 2007 (Microsoft Corp., Redmond, WA, USA). The treatment pathway, based on the model described above, for the analysis is shown in Fig. 1. Transitions are shown in more detail in Supplementary Figure 1. The model simulated changes in symptoms (frequency of micturitions and incontinence episodes, for which the model was run in parallel) at monthly intervals (i.e. 60 cycles over 5 years). Every month, patients could remain on treatment (mirabegron or tolterodine), switch to a treatment with efficacy and price similar to solifenacin or discontinue (i.e. go to ‘no treatment’). A small proportion received botulinum toxin (BTX) after this next line of therapy (this transition was not allowed directly after mirabegron or tolterodine). The probabilities of switch and discontinuation were dependent on adverse events. Patients with adverse events could stay on treatment, but incurred a disutility. Patients who discontinued treatment could naturally improve and thereby transition to a lower severity category after 1 month, or could worsen or stay the same. These patients could also restart their previous treatment, could move to a new treatment, or remain off treatment. In the event of success on BTX, patients were assumed to move to the lowest level of severity and remain there until the end of the simulation.Fig. 1

Bottom Line: The resulting incremental cost-effectiveness ratio (ICER) was £4,386/QALY gained.The probability of mirabegron 50 mg being cost effective relative to tolterodine ER 4 mg was 89.4 % at the same WTP threshold.Mirabegron 50 mg/day is likely to be cost effective compared with tolterodine ER 4 mg/day for adult patients with OAB from a UK NHS perspective.

View Article: PubMed Central - PubMed

Affiliation: Creativ-Ceutical SARL, 215, rue du Faubourg St-Honoré, 75008, Paris, France, sab@creativ-ceutical.com.

ABSTRACT

Background: Overactive bladder (OAB) is highly prevalent and is associated with considerable morbidity and reduced health-related quality of life. β3-adrenergic receptor (β3-AR) stimulation is a novel alternative to antimuscarinic therapy for OAB.

Objective: The objective of this analysis was to assess the cost effectiveness of the β3-AR agonist mirabegron relative to tolterodine extended release (ER) in patients with OAB from a UK National Health Service (NHS) perspective.

Methods: A Markov model was developed to simulate the management, course of disease, and effect of complications in OAB patients over a period of 5 years. Transition probabilities for symptom severity levels and probabilities of adverse events were estimated from the results of the randomised, double-blind SCORPIO trial in 1,987 patients with OAB. Other model inputs were derived from the literature and on assumptions based on clinical experience.

Results: Total 5-year costs per patient were £1,645.62 for mirabegron 50 mg/day and £1,607.75 for tolterodine ER 4 mg/day. Mirabegron was associated with a gain of 0.009 quality-adjusted life-years (QALYs) with an additional cost of £37.88. The resulting incremental cost-effectiveness ratio (ICER) was £4,386/QALY gained. In deterministic sensitivity analyses in the general OAB population and several subgroups, ICERs remained below the generally accepted willingness-to-pay (WTP) threshold of £20,000/QALY gained. The probability of mirabegron 50 mg being cost effective relative to tolterodine ER 4 mg was 89.4 % at the same WTP threshold.

Conclusions: Mirabegron 50 mg/day is likely to be cost effective compared with tolterodine ER 4 mg/day for adult patients with OAB from a UK NHS perspective.

Show MeSH
Related in: MedlinePlus