Puk17 Early Conversion From Intravenous to Oral Antibiotics: Assessment and Evaluation of Economic Outcomes in Hospitalized Patients

Abstract

Objectives: Antimuscarinic agents are known to have poor persistence because of bothersome adverse events and insufficient efficacy. Mirabegron is a new agent served as the treatment for patients with overactive bladder (OAB). In the absence of head-to-head trials, we evaluated comparative cost-effectiveness of mirabegron versus solifenacin in OAB patients from national health system (NHS) perspective in Iran. Methods: In this study a Markov model with a 5-year time horizon was developed consisted of five health states and OAB patients with an average age of 60 years. Transition probabilities were based on published clinical trials and network meta-analyses. Resource use and costs included those for medications and adverse events were extracted from literature and tariff book and presented in 2018 US dollars discounted at the rate of 5%. Cost-effectiveness ratios and quality-adjusted life years (QALYs) were computed for the agents. Both deterministic and probabilistic sensitivity analysis (PSA) was used to test the robustness of results. Results: Average per patient treatment costs was $2,168and $2,194 for solifenacin and mirabegron, respectively. Mirabegron is expected to produce QALYs than solifenacin (3.500 vs 3.489). In consequence, the incremental cost-effectiveness ratio of mirabegron was found to be $2,562 compared to solifenacin. Deterministic sensitivity analyses showed that the model is sensitive to changes in drug acquisition cost and urinary pad prices. In addition, the probability of mirabegron being cost-effective was found to be 74% of 1000 simulations at the threshold of $5,400 per QALY. Conclusions: Compared to solifenacin, mirabegron was indicated to be cost-effective in patients with overactive bladder for the Iranian healthcare system.