Burden On Secondary Care Of Overactive Bladder Patients Who Are Inadequately Managed With Anticholinergics In England

Abstract

LPD from Taiwan health care payer's perspective. Methods: A Markov was designed to simulate outcomes of two options in a hypothetical cohort of adult CKD patients with eGFR 15-29 mL/min/1.73m 2 : (1) Initiation of LPD plus KA, and (2) watchful-waiting on LPD and initiation of KA at eGFR < 15 mL/min/1.73m 2 . The Markov states included CKD stage 4 and 5, hemodialysis, and death. Total direct medical cost and qualityadjusted life-years (QALYs) gained were calculated over a maximum period of 10 years. Model inputs were derived from literature. Sensitivity analyses evaluated the impact of uncertainty in all model variables. Results: In base-case analysis, early KA initiation group (3.926 QALYs and USD548,191) gained higher QALYs and cost less than the watchful-waiting group (3.787 QALYs and USD887,608) (USD1= NTD30). Sensitivity analysis indicated that early KA initiation at eGFR at 17-29 mL/min/1.73m 2 would be the preferred cost-effective option if reduction of eGFR decline associated with LPD plus KA was 4% or above. When KA was initiated at eGFR 15-17 mL/min/1.73m 2 , it would remain cost-effective if the reduction of eGFR decline associated with LPD plus KA was 13.5% or above. 10,000 Monte Carlo simulations showed early KA initiation group to be less costly with higher QALY gained than watchful-waiting group by USD333,655 (95% CI 332,174-335,137) and 0.160 (95% CI 0.140-0.180) QALYs, respectively. ConClusions: KA Initiation with LPD in CKD patients as early as eGFR 15-29 mL/min/1.73m 2 seems to be cost-effective in Taiwan.

Shifting the treatment paradigm in idiopathic overactive bladder

“…The result of these strategies is that OAB patients who are inadequately managed with antimuscarinics place an increased burden on hospital resources. Cost increases by 70%, 40% and 10% for inpatient, outpatient and emergency settings, respectively, from the initial prescription to patients who have received greater than three antimuscarinic therapies 16 . In real terms, there was an increase in overall healthcare costs of 30% from the first to third or more antimuscarinic treatment cycle, equating to £197 per patient, emphasising the importance of identifying alternative methods of treating these patients to address the cumulative burden they place on healthcare systems 16 .…”

“…Cost increases by 70%, 40% and 10% for inpatient, outpatient and emergency settings, respectively, from the initial prescription to patients who have received greater than three antimuscarinic therapies 16 . In real terms, there was an increase in overall healthcare costs of 30% from the first to third or more antimuscarinic treatment cycle, equating to £197 per patient, emphasising the importance of identifying alternative methods of treating these patients to address the cumulative burden they place on healthcare systems 16 . Estimates of the individual and societal costs for the management of OAB are expected to increase, particularly as wholly effective treatments remain elusive 6 …”

“…16 In real terms, there was an increase in overall healthcare costs of 30% from the first to third or more antimuscarinic treatment cycle, equating to £197 per patient, emphasising the importance of identifying alternative methods of treating these patients to address the cumulative burden they place on healthcare systems. 16 Estimates of the individual and societal costs for the management of OAB are expected to increase, particularly as wholly effective treatments remain elusive. 6 There is no evidence to suggest that antimuscarinic treatment provides an efficacious, long-term solution.…”

“…Referral to Secondary Care is recommended once the patient does not want to try another drug, but still seeks further treatment 13 . However, Secondary Care resource costs increase by up to 30% in patients who have cycled through multiple different antimuscarinic agents, although the reasons for these cost increases have not been elucidated 16 …”

“…13 However, Secondary Care resource costs increase by up to 30% in patients who have cycled through multiple different antimuscarinic agents, although the reasons for these cost increases have not been elucidated. 16 In 2016, Chancellor et al published the Consequences of Treatment Refractory Overactive Bladder (CONTROL) study; a retrospective analysis of medical and pharmacy claims in California USA linked to a cross-sectional survey of 620 patients with OAB and UI. 17 Results showed that the mean numbers of daily UI episodes were similar, regardless of the level of antimuscarinic cycling (1, 2 or ≥3 antimuscarinics).…”