Treatments for Overactive Bladder: Focus on Pharmacotherapy

Lovatsis, Danny; Walter, Jens-Erik; Chou, Queena; Easton, William; Epp, Annette; Geoffrion, Roxana; Harvey, Marie-Andrée; Larochelle, Annick; Maslow, Kenny; Neustaedter, Grace; Pascali, Dante; Pierce, Marianne; Schulz, Jane; Senikas, Vyta; Wilkie, David

doi:10.1016/s1701-2163(16)35440-8

Cited by 33 publications

(32 citation statements)

References 71 publications

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“…35 The population (i.e., previously treated patients) was chosen to reflect current Canadian reimbursement guidelines, which recommend trial of antimuscarinic agents as first-line treatment for OAB. 14 The time horizon was one year, which was deemed sufficient to capture the healthstate utilities and costs that accrue from management of OAB, including treatment discontinuation.…”

Section: Model Overviewmentioning

confidence: 99%

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Cost-effectiveness of mirabegron compared to tolterodine ER 4 mg for overactive bladder in Canada

Herschorn¹,

Nazir²,

Ramos³

et al. 2017

CUAJ

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Introduction: This analysis compared the cost-effectiveness of once-daily regimens of mirabegron 50 mg and generic tolterodine ER 4 mg in a hypothetical cohort of previously treated patients with overactive bladder (OAB) in Canada. Methods: A Markov model was developed to represent different health states according to OAB symptoms (frequency, incontinence), presence/absence of adverse events (AEs; dry mouth, constipation, blurred vision), and treatment status (on-treatment, discontinue treatment, restart previous treatment). The time horizon used was one year, with monthly transitions between health states. The model was populated using data from a phase 3, placebo-controlled trial of mirabegron that included tolterodine as an active comparator (SCORPIO), as well as other published literature and expert opinion. Cost-effectiveness was calculated from Canadian public payer (based on Quebec list prices) and societal perspectives. Results: The incremental one-year cost per patient for mirabegron over tolterodine was $182 CAD and $157 CAD from the payer and societal perspectives, respectively. The incremental quality-adjusted life year (QALY) gain for mirabegron was 0.0066 when using EQ-5D health-state utilities. Mirabegron was cost-effective compared with tolterodine, from both payer and societal perspectives, and remained cost-effective vs. tolterodine across the majority of sensitivity analyses. The model was based on limited clinical trial evidence supplemented with expert opinion and assumptions; a select number of OAB symptoms, AEs, and direct and indirect medical costs associated with OAB; and a timeframe of only one year. Conclusions: From the payer and societal perspectives, the health economic model indicates that in Canada, mirabegron is a cost-effective treatment strategy compared with tolterodine, leading to improved health outcomes (QALYs) at an acceptable incremental cost. IntroductionOveractive bladder (OAB) is a bothersome condition with a relatively high prevalence in the general population. In a survey of over 16 500 subjects aged ≥40 years in six European countries, the prevalence of OAB was 16.6%.1 In a subsequent survey of over 19 000 subjects aged ≥18 years in Canada and Europe, the prevalence of OAB was 11.8%. OAB has a substantial negative impact on patients' health-related quality of life (HRQoL) and mental health. 5The cardinal symptoms -urgency with or without incontinence, usually associated with frequency, and nocturia 6 -interfere with basic activities of daily living, such as work, travel, sleep, interpersonal activities, sexual function, and physical activities. 7,8 Studies have often focused specifically on the impact of incontinence, but it has been shown that frequency and urgency, which are more prevalent, are as bothersome as urgency incontinence.1 In terms of mental health, it is estimated that approximately one-third of men and women with lower urinary tract symptoms may have comorbid clinical anxiety and/or depression. 9 In addition, it has been shown that the prevale...

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Section: Model Overviewmentioning

confidence: 99%

“…11,12 Treatment options for OAB can be broadly divided into conservative, pharmacological, and surgical. 13,14 Antimuscarinic agents represent a common drug treatment option for OAB that has been used for over 30 years.…”

Section: Introductionmentioning

confidence: 99%

Cost-effectiveness of mirabegron compared to tolterodine ER 4 mg for overactive bladder in Canada

Herschorn¹,

Nazir²,

Ramos³

et al. 2017

CUAJ

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“…stosowaną raz dziennie doustnie solifenacynę (Vesicare, Astellas). Solifenacyna to kompetycyjny, wybiórczy antagonista receptora muskarynowego M3, zlokalizowanego w pęcherzu moczowym [12][13][14][15][16]. Zwykle stosowana dawka to 5 mg. Może być zwiększona do 10 mg przy dobrej tolerancji leku.…”

Section: Dyskusjaunclassified

Analysis of overactive bladder symptoms after ceasing solifenacin treatment

Wlaźlak¹,

Suzin²,

Dunicz-Sokolowska³

et al. 2013

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StreszczenieWstęp: Obecnie nie posiadamy szczegółowych danych ani wytycznych dotyczących zalecanej długości stosowania terapii antymuskarynowej oraz na temat tego, w jakim czasie od zaprzestania leczenia dochodzi do nawrotu dolegliwości pęcherza nadreaktywnego. Pęcherz nadreaktywny traktowany jest jak choroba przewlekła i prawdopodobnie wymaga stałego stosowania farmakoterapii. Nieinwazyjne badanie urodynamiczne w postaci dzienniczka mikcji to podstawowy sposób potwierdzenia rozpoznania pęcherza nadreaktywnego, oceny skuteczności leczenia tej choroby oraz analizy nawrotów dolegliwości po odstawieniu leczenia.Cel pracy: Ocena nawrotu dolegliwości pęcherza nadreaktywnego po zaprzestaniu terapii solifenacyną. Materiał i metody: Badaniem objęto pacjentki z objawami pęcherza nadreaktywnego, potwierdzonego podczas nieinwazyjnego badania urodynamicznego -dzienniczka mikcji, które były zadowolone z efektu uzyskanego w wyniku terapii solifenacyną (Vesicare, Astellas) w dawce 5 mg dziennie. Po 6 miesiącach terapii zdecydowały same, że przerwą leczenie. Pacjentki były zaproszone na wizytę kontrolną po 3 i 6 miesiącach od zaprzestania terapii.Wyniki: Analizą wstępnie objęto 37 kobiet w wieku 31-78 lat (średnio 62,8 roku). Na wizytę po 3 miesiącach od zaprzestania leczenia zgłosiły się 34 pacjentki. Kryteria włączenia terapii solifenacyną spełniało 8 pacjentek. Na wizycie po 6 miesiącach kryteria włączenia terapii solifenacyną spełniało 12 spośród 23 kobiet. Stwierdzono istotne statystycznie zwiększenie liczby mikcji oraz parć naglących po 3 i po 6 miesiącach od odstawienia solifenacyny.Wnioski: W ciągu 6 miesięcy od odstawienia solifenacyny nastąpił nawrót dolegliwości pęcherza nadreaktywnego u większości pacjentek, u których lek ten skutecznie zlikwidował wcześniej występujące objawy.Słowa kluczowe: pęcherz nadreaktywny, solifenacyna, przerwanie terapii, dzienniczek mikcji, badanie urodynamiczne. SummaryIntroduction: Nowadays there are neither detailed data nor guidelines concerning the recommended length of antimuscarinic treatment and the time of complaints recurring after ceasing the treatment. Overactive bladder is a chronic disease so probably constant treatment is needed. Non-invasive urodynamic studies in the form of a micturition diary are the basic way to confirm overactive bladder diagnosis, to evaluate the treatment efficacy of this disease and to perform the analysis of recurrence of complaints after ceasing the treatment.Aim of the study: The aim of the study was the evaluation of the recurrence of overactive bladder complaints after ceasing solifenacin treatment.Material and methods: The study included patients with overactive bladder complaints which were confirmed during non-invasive urodynamic studies (micturition diary) and were satisfied with the solifenacin (Vesicare, Astellas) treatment at a daily dose of 5 mg. After 6 months they decided by themselves to cease the treatment. Women were asked to come for a follow-up visit 3 and 6 months after the therapy was stopped.

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“…The direct cost of OAB in Canada is about $175 million; this figure is increased to $352 million when accounting for urgency urinary incontinence. 9,11 The estimated annual cost of OAB per patient to the Canadian health system is about $11 329 per annum. 4,9 Different treatment options are available for OAB, including lifestyle or behavioural changes, such as pelvic floor strengthening, bladder retraining, and management of daily Economic evaluation of SNM in OAB fluid intake.…”

Section: Introductionmentioning

confidence: 99%

“…[13][14][15] This inhibition disrupts the frequent spontaneous contractions that occur during the bladder filling. 11,16 A newer group of pharmacological agents based on the use of beta 3 agonists, such as myrabegron, have been added to the armamentarium of drugs for OAB. 2 There are serious systemic side effects for these anticholinergic drugs.…”

Section: Introductionmentioning

confidence: 99%

Economic evaluation of sacral neuromodulation in overactive bladder: A Canadian perspective

Hassouna

Sadri

2015

CUAJ

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Introduction: Refractory overactive bladder (OAB) with urge incontinence is an underdiagnosed condition with substantial burden on the healthcare system and diminished patient's quality-of-life. Many patients will fail conservative treatment with optimized medical-therapy (OMT) and may benefit from minimally invasive procedures, including sacral-neuromodulation (SNM) or botulinum-toxin (BonT-A). The goal of this study was to estimate the costefectiveness of SNM vs. OMT and BonT-A as important parameters from coverage and access to a therapy. Methods: A Markov model with Monte-Carlo simulation was used to assess the incremental cost effectiveness ratio (ICER) of SNM vs. BonT-A and OMT both in deterministic and probabilistic analysis from a provincial payer perspective over a 10-year time horizon with 9-month Markov-cycles. Clinical data, healthcare resource utilization, and utility scores were acquired from recent publications and an expert panel of 7 surgeons. Cost data (2014-Dollars) were derived from provincial health insurance policy, drug benefit formulary, and hospital data. All cost and outcomes were discounted at a 3% rate. Results: The annual (year 1-10) incremental quality-adjusted life years for SNM vs. BonT-A was 0.05 to 0.51 and SNM vs. OMT was 0.19 to 1.76. The annual incremental cost of SNM vs. BonT-A was $7237 in year 1 and -$9402 in year 10 and was between $8878 and -$11 447 vs. OMT. In the base-case deterministic analysis, the ICER for SNM vs. BonT-A and OMT were within the acceptable range ($44 837 and $15 130, respectively) at the second year of therapy, and SNM was dominant in consequent years. In the basecase analysis the probability of ICER being below the acceptability curve (willingness-to-pay $50 000) was >99% for SNM vs. BonT-A at year 3 and >95% for OMT at year 2. Conclusion: SNM is a cost-effective treatment option to manage patients with refractory OAB when compared to either BonT-A or OMT. From a Canadian payers' perspective, SNM may be considered a first-line treatment option in management of patients with OAB with superior long-term outcomes. Similar to all economic analysis, this study has limitations which are based on the assumptions of the used model.

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Treatments for Overactive Bladder: Focus on Pharmacotherapy

Cited by 33 publications

References 71 publications

Cost-effectiveness of mirabegron compared to tolterodine ER 4 mg for overactive bladder in Canada

Cost-effectiveness of mirabegron compared to tolterodine ER 4 mg for overactive bladder in Canada

Analysis of overactive bladder symptoms after ceasing solifenacin treatment

Economic evaluation of sacral neuromodulation in overactive bladder: A Canadian perspective

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