Improved persistence observed in routine clinical practice with mirabegron appears to translate into benefits of reduced healthcare resource use, and lower direct and indirect costs of treatment compared with antimuscarinics. Overall, these data suggest that mirabegron may offer clinical and economic benefits for the management of patients with OAB in Canada.

PurposeOur objective was to estimate the economic outcomes of using mirabegron versus antimuscarinics in the treatment of patients with overactive bladder (OAB) from a societal perspective in the UK.Materials and MethodsA Markov model was developed using Microsoft Excel®. The time horizon and cycle length are 12 and 1 months, respectively; and the hypothetical cohort size 100 patients. Antimuscarinic comparators are fesoterodine, oxybutynin extended release (ER) and immediate release (IR), solifenacin, tolterodine ER/IR, trospium ER/IR, darifenacin and flavoxate. Model inputs included real-world treatment patterns data, healthcare resource use (e.g. clinic visits) and direct and indirect costs (e.g. drug acquisition and productivity loss). Model outputs included patient disposition, healthcare resource use, drug acquisition costs and other treatment-related costs over a 1-year time horizon. A one-way sensitivity analysis was performed to determine the key drivers of the model.ResultsIn a hypothetical cohort of 100 patients, total annual costs per patient were lower with mirabegron than with all antimuscarinics (£1270.84 vs. 1321.71–1607.48). Healthcare resource use was lower with mirabegron than with all antimuscarinics (115 vs. 119–123 general practitioner visits; 173 vs. 178–185 specialist visits and 0.0042 vs. 0.0050–0.0060 surgical operations) and fewer work hours were lost (4017 vs. 5114–6990 [all per 100 patients]). Sensitivity analysis showed the model was sensitive to persistence and switching rates, although the impact on the overall results was minimal.ConclusionsIn the UK, using mirabegron to treat OAB may improve persistence and lead to reductions in switching treatment, healthcare resource utilization, productivity costs, and overall treatment costs versus antimuscarinics.Electronic supplementary materialThe online version of this article (doi:10.1007/s41669-017-0011-x) contains supplementary material, which is available to authorized users.

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Objectives: This work investigates the budget impact of introducing 3D digital breast tomosynthesis (DBT) compared to 2D digital mammography (FFDM) for detecting breast cancer when screening asymptomatic women in the German statutory health insurance system. Methods: Number of women screened was estimated based on the mammography screening report. Detection and recall rates, sensitivity and specificity for DBT and FFDM as well as costs for treating interval cancer were obtained from literature. For immediate costs, administrative reimbursement prices were used. For follow-up costs, administrative prices for X-ray or sonography guided diagnostic (EBM clarification diagnosis I) were used. Two hypothetical scenarios were established: scenario A, where women with dense breasts (BI-RADS C and D) receive DBT while all others receive FFDM and scenario B, where DBT is used in all women. Budget impact was estimated as add-on costs between hypothetical scenarios and status-quo, where only FFDM is used. Results: In status quo, costs were 216.98mn V for 17,204 identified cancers, i.e. 12,612 V per identified cancer. In scenario A, 1,146,904 women were screened with DBT and 1,583,820 with FFDM. Immediate add-on costs were 98.660mn V and 2.068mn V for follow-up costs. 4,251 additional cancers were identified, thereof 413 interval cancers, equivalent to savings of 2.416mn V. Budget impact was 98.308mn V. Additional Costs per cancer diagnosis were 2,083 V. In scenario B, 2,730,724 women were screened with DBT. Immediate add-on costs were 234.904mn V and follow-up costs 4.926mn V. 7,100 additional tumors were identified, thereof 983 interval cancers with savings of 5.754mn V. Budget impact was 234.075mn V. Additional costs per cancer diagnosis were 3,863 V. Conclusions: When using 3D mammography in scenario A, 4,251 additional cancers could be diagnosed with 2,083 V additional costs per diagnosis. 3D mammography could thus be a cost-effective screening instrument.

Objectives: Hematological cancers are amongst the diseases that pose the highest burden on patients in terms of reduced quality of life, frequent relapses and reductions in life expectancy. For multiple myeloma (MM), lenalidomide-based therapy options significantly prolong progression-free survival (PFS) and overall survival (OS). Longer PFS, in turn, yields economic and societal gains as it enables patients to pursue their every-day activities and participate in the labor market. The purpose of this study was twofold: (1) To quantify the health benefits of using lenalidomide in the treatment of multiple myeloma and (2) to measure the socio-economic benefits that are associated with this improved health. We considered, retrospectively, the benefits of lenalidomide since its introduction in 2007 as well as its prospective effects up to the year 2030. Methods: We built an open cohort dynamic population model. The gains in PFS associated with the use of lenalidomide were projected to the overall MM patient population in Germany. Using German administrative employment data and information from time use surveys, we translated these PFS advantages into productivity gains. Gains in OS were valued with the statistical value of a life year (VSLY). Cost calculations distinguished between costs for lenalidomide and additional treatment costs in combination therapies. Results: Through 2030, about 64 thousand progression-free years can be gained by utilizing lenalidomide as compared to the respective best alternative therapy. Including the VSLY, the societal impact amounts to about EUR 21.0 billion. Total additional costs for the treatment of MM patients with lenalidomide-based regimens sum up to EUR 12.8 billion, resulting in a value-invest ratio of about 1.65. Conclusions: Our study shows that the benefits of the use of lenalidomide in the treatment of MM extend beyond clinical advantages. Due to longer PFS and OS, this treatment also yields positive economic and societal effects.