This study assessed persistence and adherence (or compliance) with medications prescribed for OAB in a large UK population. We found that patients prescribed mirabegron remained on treatment for longer and showed greater adherence than those prescribed traditional antimuscarinics.

BackgroundTo assess treatment persistence and adherence in men ≥45 years of age with lower urinary tract symptoms (LUTS) associated with benign prostatic hyperplasia (BPH), using prescription records from the Netherlands IMS Lifelink™ LRx database.MethodsIn this retrospective, observational cohort study, we identified men who received combination therapy with an α-blocker plus an antimuscarinic (e.g. solifenacin or tolterodine) between 1 November 2013 and 31 October 2014. Treatment could be received as a fixed-dose combination (FDC) tablet or as two drugs administered together (concomitant therapy), if both combination drugs were prescribed within 30 days. The primary objective was to assess treatment persistence, defined as the time from initiation of combination therapy until first discontinuation of the FDC or at least one of the drugs given concomitantly (i.e. ≥30 days without prescription renewal). Subgroup and sensitivity analyses were conducted to assess persistence by antimuscarinic agent, and with different gap lengths used to define discontinuation (45, 60 and 90 days), respectively.ResultsA total of 1891 men received an α-blocker plus an antimuscarinic (FDC, N = 665; concomitant therapy, N = 1226). Median time to discontinuation was significantly longer with FDC versus concomitant therapy (414 vs. 112 days; adjusted hazard ratio [HR] 2.04, 95% confidence interval 1.77, 2.35; p < 0.0001). Persistence at 12 months (51.3% vs. 29.9%) was also significantly greater with FDC compared with concomitant therapy. Assessment of antimuscarinic subgroups showed that median time to discontinuation was longest with solifenacin combinations (214 days) compared with other antimuscarinic combinations (range, 47–164 days; adjusted HR range, 1.27–1.77, p = 0.037). No observable impact on treatment persistence was found by adjusting the gaps used to define discontinuation.DiscussionThis study of real-world evidence of men with LUTS/BPH treated with α-blocker plus antimuscarinic combination therapy in the Netherlands showed that treatment persistence was significantly greater in those who received a FDC tablet compared with combination therapy given concomitantly. The study also shows that treatment persistence was extended in men who received combination therapy containing solifenacin compared with other antimuscarinics.ConclusionsOverall, these findings may be useful for prescribers, as improved persistence on-treatment may translate into improved outcomes for men with LUTS/BPH. Further study is warranted to establish the key drivers of persistence in men receiving combination therapy for LUTS/BPH.Electronic supplementary materialThe online version of this article (doi:10.1186/s12894-017-0226-2) contains supplementary material, which is available to authorized users.

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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The aim of this study was to estimate the economic burden of Autosomal dominant polycystic kidney disease (ADPKD) in Italy, analyzing direct costs according to progression stage of chronic kidney disease (CKD). The primary endpoint was the average annual cost per patient with ADPKD in Italy. The secondary endpoint was represented by the average annual cost per patient suffering from ADPKD for CKD I to CKD V (not under dialysis), dialysis and post-transplant stage. MethOds: This retrospective, observational study was carried out by gathering data through a pre-specified Case Report Form (CRF) in six Italian hospitals. Costs associated with ADPKD were estimated based on identified cost drivers and the analysis was performed using the Activity-Based Costing method. Inpatient and outpatient resource consumption was collected for each patient during the period 2012-2015. Direct costs were then calculated from the perspective of the Italian National Health Service (NHS). Results: 191 patients were enrolled. The analysis estimated an average annual cost associated with ADPKD management of € 7,921. The average annual cost of patients under dialysis was € 27,353, followed by post-trasplantation and CKD V patients (respectively € 22,793 and € 12,658), CKD IV (€ 7,320) and finally CKD III, CKD II, CKD I (respectively € 723.75, € 674.5 and € 159.7). Costs increased with disease progression, except for post-transplant stage. The outpatient specialist care (including dialysis) represented the highest impact on total costs, followed by pharmacological therapies and hospitalizations. cOnclusiOns:The study underlined the relevant economic burden of ADPKD and its direct correlation with disease stage, suggesting the importance of slowing down disease progression, both for patient in terms of quality of life and the NHS budget.