title: Cost-effectiveness analysis of newer anticholinergic drugs for urinary incontinence vs oxybutynin and no treatment using data on persistence from the Swedish prescribed drug registry.
abstract: Study Type - Therapy (cost effectiveness). Level of Evidence 2a. What's known on the subject? and What does the study add? Anticholinergic drugs are a common treatment alternative in urinary incontinence, which results in large costs for caregivers. So far, most cost-effectiveness analyses of anticholinergic drugs have focused on small putative differences between the newer anticholinergics. This study takes a novel approach by treating the clinical effects of the newer alternatives as similar and evaluating them as a group in relation to no treatment and oxybutynin (immediate release). It also uses registry data to account for persistence.
  
  
  OBJECTIVE
  • To analyse the cost-effectiveness of newer anticholinergic drugs in relation to oxybutynin immediate release (IR) and no treatment for patients with urgency urinary incontinence.
  
  
  METHODS
  • A decision analytic model was constructed. • Results were collected from randomized trials and combined with registry data on persistence of medicine use and estimated number of severe adverse events. • The setting corresponds to Swedish clinical practice. • The costs and effects of the treatment options were analysed over a period of 1 year. Costs included drug costs, treatment costs and costs for pad use. Patients' utilities were based on treatment effect and the lack or presence of adverse events.
  
  
  RESULTS
  • No treatment was the least costly treatment but also resulted in the fewest number of quality adjusted life years (QALYs). • Treatment with newer anticholinergic drug medications is the most costly option but also the most efficient treatment. Sensitivity analyses showed that the results were robust. • Treatment with newer anticholinergics resulted in a cost per QALY gained of €21 045 compared with no treatment and no effect and €65 435 compared with no treatment and placebo effect. Compared with oxybutynin IR, the cost per QALY gained was €37 119. These calculations are based on relatively low pad costs, resulting in higher costs per QALY for the original drugs.
  
  
  CONCLUSIONS
  • The newer anticholinergic medications are likely to be cost effective in relation to oxybutynin IR. • The cost-effectiveness of the newer anticholinergics compared with no treatment depends on assumptions of the effect of no treatment, the severity of the treated condition and the treated individual's risk of adverse events. • Treatment is less likely to be cost effective for elderly persons or for persons otherwise at higher risk for adverse events.
authors.affiliation: Swedish Dental and Pharmaceutical Benefits Agency, Stockholm, Sweden. fredrik.nilsson@tlv.se
authors.forename: Fredrik O L
authors.initials: FO
authors.lastname: Nilsson
authors.forename: Love
authors.initials: L
authors.lastname: Linnér
authors.forename: Eva
authors.initials: E
authors.lastname: Samuelsson
authors.forename: Ian
authors.initials: I
authors.lastname: Milsom
mesh_terms: D018680:Cholinergic Antagonists / Q000191:economics* / Q000627:therapeutic use; D003362:Cost-Benefit Analysis; D016527:Drug Costs; D006801:Humans; D016496:Incontinence Pads / Q000191:economics; D008333:Mandelic Acids / Q000191:economics* / Q000627:therapeutic use; D011788:Quality of Life; D019057:Quality-Adjusted Life Years; D053202:Urinary Incontinence, Urge / Q000188:drug therapy* / Q000191:economics
chemical_list: D018680:Cholinergic Antagonists; D008333:Mandelic Acids; C005419:oxybutynin