Cost-effectiveness analysis of solifenacin versus oxybutynin immediate-release in the treatment of patients with overactive bladder in the United Kingdom. (October 2013)

• Record Type: Journal Article
• Authors: Hart, Warren Mark; Abrams, Paul; Munro, Vicki; Retsa, Peny; Nazir, Jameel
• Is Part Of: Journal of medical economics. Volume 16:Number 10(2013)
• Page Start: 1246
• Page End: 1254
• Publication Date: 2013-10
• Subjects: Medical care -- Cost control -- Periodicals; Medical economics -- Periodicals; 362.10941
• DOI: 10.3111/13696998.2013.829079
• Languages: English
• ISSNs: 1369-6998

Abstract

<abstract> <title>Abstract</title> <sec id="ss1"> <title>Objective:</title> <p>To carry out a cost-utility analysis comparing initial treatment with solifenacin 5 mg/day vs oxybutynin immediate-release (IR) 15 mg/day for the treatment of patients with overactive bladder (OAB) from the perspective of the UK National Health Service (NHS).</p> </sec> <sec id="ss2"> <title>Methods:</title> <p>A Markov model with six health states was developed to follow a cohort of OAB patients treated with either solifenacin or oxybutynin during a 1-year period. Costs and utilities were accumulated as patients transited through the health states in the model and a drop-out state. Some of the solifenacin patients were titrated from 5 mg to 10 mg/day at 8 weeks. A proportion of drop-out patients were assumed to continue treatment with tolterodine ER. Utility values were obtained from a Swedish study and pad use was based on a multinational clinical trial. Adherence rates for individual treatments were derived from a UK database study. For pad use and utility values, the drop-out state was split between those patients who were no longer receiving treatment and those on second-line therapy. Patients on second-line therapy who drop-out were referred for a specialist visit. Results were expressed in terms of incremental cost-utility ratios.</p> </sec> <sec id="ss3"> <title>Results:</title> <p>Total annual costs for solifenacin and oxybutynin were £504.30 and £364.19, respectively. First-line drug use represents 49% and 4% of costs and pad use represent 23% and 40% of costs for solifenacin and oxybutynin, respectively. Differences between cumulative utilities were small but were greater for solifenacin (0.7020 vs 0.6907). The baseline incremental cost-effectiveness ratio was £12, 309/QALY.</p> </sec> <sec id="ss4"> <title>Conclusion:</title> <p>Under the baseline assumptions, solifenacin would appear to be cost-effective with an incremental cost-utility of less than £20, 000/QALY. However, small differences in utility between the alternatives and the large number of drop-outs means that the results are sensitive to small adjustments in the values of utilities assigned to the drop-out state.</p> </sec> </abstract>