A cost-utility analysis of once daily solifenacin compared to tolterodine in the treatment of overactive bladder syndrome.
OBJECTIVE
To evaluate the cost-utility of solifenacin, a new generation antimuscarinic, compared with tolterodine in the treatment of overactive bladder syndrome (OAB), from the perspective of the UK National Health Service (NHS).


METHODS
A 1-year Markov model was constructed using data from a 12-week, randomised, double-blind study that compared flexible dosing with solifenacin (5 mg and 10 mg) with tolterodine (IR 2 mg bd/ER 4 mg) in adults with OAB. The model incorporated five discrete health states that were based on disease severity (micturitions/day and incontinence episodes/day). A 'drop out' state was also used in the model to account for patients that discontinued treatment in the first year. UK-specific costs for drug treatment and pad use as well as utilities were assigned to each health state.


RESULTS
Solifenacin was a less costly and more effective treatment strategy compared with tolterodine. During the course of 1 year, the estimated cost per patient was pound509 for patients treated with solifenacin and pound526 for those given tolterodine, a cost saving of pound17 per patient. Treatment with solifenacin was also associated with a small incremental gain of 0.004 quality-adjusted-life-years (QALYs) over tolterodine. Sensitivity analysis suggests that the incremental cost effectiveness of solifenacin relative to tolterodine does not appear to exceed pound30 000/QALY with even large variations in key model parameters.


CONCLUSIONS
Flexible dosing with solifenacin is likely to be cost-effective versus tolterodine in the treatment of OAB. Further studies are needed to confirm these results.
Musgrove Park Hospital, Taunton, UK.
Mark
M
Speakman
Vik
V
Khullar
Anthony
A
Mundy
Isaac
I
Odeyemi
John
J
Bolodeoku
D001559:Benzhydryl Compounds / Q000191:economics / Q000627:therapeutic use*; D003362:Cost-Benefit Analysis; D003408:Cresols / Q000191:economics / Q000627:therapeutic use*; D004311:Double-Blind Method; D006801:Humans; D008390:Markov Chains; D018727:Muscarinic Antagonists / Q000191:economics / Q000627:therapeutic use*; D010665:Phenylpropanolamine / Q000191:economics / Q000627:therapeutic use*; D011812:Quinuclidines / Q000191:economics / Q000627:therapeutic use*; D000069464:Solifenacin Succinate; D044005:Tetrahydroisoquinolines / Q000191:economics / Q000627:therapeutic use*; D000068737:Tolterodine Tartrate; D053201:Urinary Bladder, Overactive / Q000188:drug therapy*
D001559:Benzhydryl Compounds; D003408:Cresols; D018727:Muscarinic Antagonists; D011812:Quinuclidines; D044005:Tetrahydroisoquinolines; D010665:Phenylpropanolamine; D000068737:Tolterodine Tartrate; D000069464:Solifenacin Succinate