Solifenacin in the treatment of overactive bladder syndrome in Italian patients: pharmacoeconomic evaluation.
OBJECTIVE
To investigate the pharmacoeconomic performance of treatment with solifenacin, a new antimuscarinic with selectivity for the bladder, when compared to tolterodine and placebo, in Italian patients with overactive bladder (OAB).


METHODS
The evaluation was performed using a Markov model. The time horizon of the simulation was 52 weeks, with 1-week cycles. The model simulated outcomes and costs of the treatment with solifenacin (5 mg/day), tolterodine ER (4 mg/day) and no treatment in a cohort representative of the Italian population with OAB. The analysis was conducted mainly from the perspective of the patient, since drugs for the treatment of OAB are not included in the Italian reimbursement list. A supplementary scenario explored the consequences of a hypothetical reimbursement decision by the Italian Health Service to reimburse half of the current retail price in incontinent and responding OAB patients only.


RESULTS
Both treatments produced a reduction in symptoms and improvement in patients' quality of life, with an cost increase of about euro 540-640/patient/year with solifenacin and euro 680-780/patient/year with tolterodine. In a cost/utility analysis, solifenacin dominated tolterodine as it resulted in both more effective and less costly treatment; the cost/utility ratio with respect to no treatment was in the range euro 7,600-18,600/Quality-adjusted life year. The overall expenditure of the hypothesised reimbursement decision was estimated to be about 23 million euros, with a cost/utility ratio of about euro 600-2,400/Quality-adjusted life year, indicating an efficient allocation of health resources.


CONCLUSIONS
While both tolterodine and solifenacin appear to be cost/effective in Italy, the latter has proven to be superior.
Pradelli
Lorenzo
L
AdRes Health Economics and Outcomes Research, Torino (Turin), Italy. l.pradelli@advancedresearch.it
Iannazzo
Sergio
S
D001559:Benzhydryl Compounds / Q000191:economics* / Q000627:therapeutic use; D003198:Computer Simulation; D003362:Cost-Benefit Analysis; D003408:Cresols / Q000191:economics* / Q000627:therapeutic use; D006801:Humans; D007558:Italy; D008390:Markov Chains; D018727:Muscarinic Antagonists / Q000191:economics* / Q000627:therapeutic use; D010597:Pharmacogenetics / Q000379:methods*; 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 / Q000150:complications / Q000188:drug therapy* / Q000191:economics*; D014549:Urinary Incontinence / Q000188:drug therapy / Q000191:economics* / Q000209:etiology / Q000517:prevention & control
D001559:Benzhydryl Compounds; D003408:Cresols; D018727:Muscarinic Antagonists; D011812:Quinuclidines; D044005:Tetrahydroisoquinolines; D010665:Phenylpropanolamine; D000068737:Tolterodine Tartrate; D000069464:Solifenacin Succinate