Background: Overactive bladder (OAB) is a chronic condition which may be associated with a significant negative impact on quality of life. Antimuscarinic drugs are currently the mainstay of medical therapy, but persistence and adherence are generally poor. Treatment switching may be considered in order to maximise benefits from pharmacological therapy, but there are relatively few data on OAB therapy switching to second and third-lines of medication. There are also few formal analyses on the impact of age, gender and choice of initial OAB drug on discontinuation rates. Objectives: To investigate discontinuation rates with antimuscarinics in patients newly starting OAB therapy, with regard to patterns of switching to alternative medication, and the potential impact of age, gender and choice of initial drug.</p> Methods: Data on prescription drug use in Canada were retrieved from the IMS Brogan public and private prescription claims databases. Medication usage was tracked for four years following an index claim. The primary endpoint was the number of days from index claim to discontinuation of medication. Secondary endpoints were the number of days on first-line therapy before switching. Descriptive results were evaluated using univariate (Kaplan-Meier) and multivariate (Cox proportional hazards) models. Results: Data were available for 31,754 patients. Approximately 91% discontinued OAB medication within the four-year follow-up period. The discontinuation rate was similar between men and women. The risk of discontinuation in patients ≥75 years was only slightly higher than that in patients aged 40−64 years (hazard ratio of 1.08) and was lower than in those aged 65−74 years. Retention when oxybutynin was the initial drug was lower than with most of the other antimuscarinics. Only 12.5% of patients changed OAB medication during the 4-year period. Women were more likely than men to switch from first-line or second-line treatment. Conclusions: Discontinuation of initial antimuscarinic therapy was high. Compared with oxybutynin, several alternative antimuscarinics offered lower risks of discontinuation. The majority of patients had no trial of second-line treatment.

Background Current treatments for hemophilia A in Canada include on-demand treatment as bleeds occur and regular intravenous prophylactic factor VIII (FVIII) infusions. The subcutaneous therapy emicizumab was recently approved for treatment of hemophilia A. The objective of this study was to estimate utility values associated with hemophilia A health and treatment states from a Canadian societal perspective, including preferences related to treatment efficacy and frequency and route of administration. Methods A vignette-based time trade-off (TTO) utilities elicitation was undertaken in Canadian adults to compare preferences for six hemophilia health states describing prophylactic and on-demand treatment, with varying bleed rates and frequency of treatment administration. A convenience sample was recruited via market research panels and snowball sampling. Health state/vignette definitions were informed by clinical experience, clinical trial results regarding bleed frequency, and validated by qualitative interviews of hemophilia patients and caregivers (n=10). Utilities were estimated via an online, trained interviewer-guided, vignette-based TTO exercise, where respondents valuated health states describing hemophilia patients (adults or children) receiving subcutaneous prophylaxis, intravenous prophylaxis, and on-demand treatments. Analyses included a descriptive analysis by health state; a mixed-effects analysis of utility values adjusted for subcutaneous vs infusion-based therapies and number of bleeds; and for prophylactic regimens, an analysis of utilities by frequency of infusions or injections. Results TTO interviews were conducted with 82 respondents. Mean utilities [95% CI] were highest for subcutaneous prophylaxis (0.90 [0.87–0.93]), followed by intravenous prophylaxis (0.81 [0.78–0.85]), and on-demand treatment (0.70 [0.65–0.76]). In regression analysis, subcutaneous treatment health states were associated with a utility increment of +0.1112. Additional bleeds and more frequent infusions were associated with lower utility values (−0.0027 per bleed and −0.0003 per infusion). Conclusion Subcutaneous prophylaxis is associated with higher utility values compared to intravenous prophylactic and on-demand treatment, while increased bleeds and infusions are associated with reduced utility.

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Background: Hemophilia A is caused by a mutation of clotting factor genes resulting in a deficiency of factor VIII (FVIII). Current treatments for hemophilia A in Canada include on-demand treatment as bleeds occur and regular intravenous prophylactic FVIII infusions. The subcutaneous therapy emicizumab was recently approved for the treatment of hemophilia A. The objective of this study was to estimate utility values associated with hemophilia A health and treatment states from a Canadian societal perspective, including preferences related to treatment efficacy as well as frequency and route of administration.Methods: A vignette-based time trade-off (TTO) utilities elicitation was undertaken to compare population preferences for 6 hemophilia health states describing prophylactic and on-demand treatment, with varying bleed rates and frequency of treatment administration. Health state definitions were informed by clinical experience, HAVEN3 results regarding bleed frequency, and supplemented with qualitative interviews of hemophilia patients and caregivers (n=10). Results: TTO interviews were conducted with 82 general population respondents. Mean utilities [95% CI] were highest for subcutaneous prophylaxis (0.90 [0.87-0.93]), followed by intravenous prophylaxis (0.81 [0.78-0.85]), with on-demand having the lowest utility (0.70 [0.65-0.76]). In regression analysis, subcutaneous treatment health states were associated with a utility increment of +0.1112. Additional bleeds and more frequent infusions were associated with lower utility values (-0.0027 per bleed and -0.0003 per infusion, respectively). Conclusion: Subcutaneous prophylaxis is associated with higher utility values compared to intravenous prophylactic and on-demand treatment, while increased bleeds and infusions are associated with reduced utility.