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Clinical Trial
. 2015 Feb;35(2):83-93.
doi: 10.1007/s40261-014-0240-z.

Cost effectiveness of mirabegron compared with tolterodine extended release for the treatment of adults with overactive bladder in the United Kingdom

Samuel Aballéa  1 , Khaled Maman, Katia Thokagevistk, Jameel Nazir, Isaac A O Odeyemi, Zalmai Hakimi, Andy Garnham, Mondher Toumi
Affiliations
Clinical Trial

Cost effectiveness of mirabegron compared with tolterodine extended release for the treatment of adults with overactive bladder in the United Kingdom

Samuel Aballéa et al. Clin Drug Investig. 2015 Feb.

Abstract

Background: Overactive bladder (OAB) is highly prevalent and is associated with considerable morbidity and reduced health-related quality of life. β3-adrenergic receptor (β3-AR) stimulation is a novel alternative to antimuscarinic therapy for OAB.

Objective: The objective of this analysis was to assess the cost effectiveness of the β3-AR agonist mirabegron relative to tolterodine extended release (ER) in patients with OAB from a UK National Health Service (NHS) perspective.

Methods: A Markov model was developed to simulate the management, course of disease, and effect of complications in OAB patients over a period of 5 years. Transition probabilities for symptom severity levels and probabilities of adverse events were estimated from the results of the randomised, double-blind SCORPIO trial in 1,987 patients with OAB. Other model inputs were derived from the literature and on assumptions based on clinical experience.

Results: Total 5-year costs per patient were £1,645.62 for mirabegron 50 mg/day and £1,607.75 for tolterodine ER 4 mg/day. Mirabegron was associated with a gain of 0.009 quality-adjusted life-years (QALYs) with an additional cost of £37.88. The resulting incremental cost-effectiveness ratio (ICER) was £4,386/QALY gained. In deterministic sensitivity analyses in the general OAB population and several subgroups, ICERs remained below the generally accepted willingness-to-pay (WTP) threshold of £20,000/QALY gained. The probability of mirabegron 50 mg being cost effective relative to tolterodine ER 4 mg was 89.4 % at the same WTP threshold.

Conclusions: Mirabegron 50 mg/day is likely to be cost effective compared with tolterodine ER 4 mg/day for adult patients with OAB from a UK NHS perspective.

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Figures

Fig. 1
Fig. 1
Markov treatment pathway. BTX botulinum toxin, ER extended release, OAB overactive bladder syndrome
Fig. 2
Fig. 2
Deterministic sensitivity analysis. AE adverse event, BTX botulinum toxin, EQ5D European Quality of Life questionnaire in five dimensions, ICER incremental cost-effectiveness ratio
Fig. 3
Fig. 3
Cost-effectiveness acceptability curve for mirabegron 50 mg vs tolterodine extended release 4 mg; general OAB population. OAB overactive bladder syndrome, QALY quality-adjusted life year
See this image and copyright information in PMC

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