title: Health economics perspective of fesoterodine, tolterodine or solifenacin as first-time therapy for overactive bladder syndrome in the primary care setting in Spain.
abstract: BACKGROUND
  Overactive bladder (OAB) is associated with high healthcare costs, which may be partially driven by drug treatment. There is little comparative data on antimuscarinic drugs with respect to resource use and costs. This study was conducted to address this gap and the growing need for naturalistic studies comparing health economics outcomes in adult patients with OAB syndrome initiating treatment with different antimuscarinic drugs in a primary care setting in Spain.
  
  
  METHODS
  Medical records from the databases of primary healthcare centres in three locations in Spain were assessed retrospectively. Men and women ≥18 years of age who initiated treatment with fesoterodine, tolterodine or solifenacin for OAB between 2008 and 2010 were followed for 52 weeks. Healthcare resource utilization and related costs in the Spanish National Health System were compared. Comparisons among drugs were made using multivariate general linear models adjusted for location, age, sex, time since diagnosis, Charlson comorbidity index, and medication possession ratio.
  
  
  RESULTS
  A total of 1,971 medical records of patients (58.3% women; mean age, 70.1 [SD:10.6] years) initiating treatment with fesoterodine (n = 302), solifenacin (n = 952) or tolterodine (n = 717) were examined. Annual mean cost per patient was €1798 (95% CI: €1745; €1848). Adjusted mean (95% bootstrap CI) healthcare costs were significantly lower in patients receiving fesoterodine (€1639 [1542; 1725]) compared with solifenacin (€1780 [€1699; €1854], P = 0.022) or tolterodine (€1893 [€1815; €1969], P = 0.001). Cost differences occurred because of significantly fewer medical visits, and less use of absorbent products and OAB-related concomitant medication in the fesoterodine group.
  
  
  CONCLUSIONS
  Compared with solifenacin and tolterodine, fesoterodine was a cost-saving therapy for treatment of OAB in the primary care setting in Spain.
authors.affiliation: Directorate of Planning, Badalona Serveis Assistencials SA, Calle Gaietà Soler, 6-8 entlo, CP 08911 Badalona, Barcelona, Spain. asicras@bsa.cat.
authors.forename: Antoni
authors.initials: A
authors.lastname: Sicras-Mainar
authors.forename: Javier
authors.initials: J
authors.lastname: Rejas
authors.forename: Ruth
authors.initials: R
authors.lastname: Navarro-Artieda
authors.forename: Alba
authors.initials: A
authors.lastname: Aguado-Jodar
authors.forename: Amador
authors.initials: A
authors.lastname: Ruiz-Torrejón
authors.forename: Jordi
authors.initials: J
authors.lastname: Ibáñez-Nolla
authors.forename: Marion
authors.initials: M
authors.lastname: Kvasz
mesh_terms: D000368:Aged; D001559:Benzhydryl Compounds / Q000191:economics / Q000627:therapeutic use; D018678:Cholinergic Agents / Q000191:economics* / Q000627:therapeutic use*; D003362:Cost-Benefit Analysis; D003408:Cresols / Q000191:economics / Q000627:therapeutic use; D005260:Female; D017048:Health Care Costs / Q000706:statistics & numerical data*; D006801:Humans; D008297:Male; D010665:Phenylpropanolamine / Q000191:economics / Q000627:therapeutic use; D015995:Prevalence; D011320:Primary Health Care / Q000191:economics* / Q000706:statistics & numerical data; D011812:Quinuclidines / Q000191:economics / Q000627:therapeutic use; D012189:Retrospective Studies; D000069464:Solifenacin Succinate; D013030:Spain / Q000453:epidemiology; D013577:Syndrome; D044005:Tetrahydroisoquinolines / Q000191:economics / Q000627:therapeutic use; D000068737:Tolterodine Tartrate; D016896:Treatment Outcome; D053201:Urinary Bladder, Overactive / Q000188:drug therapy* / Q000191:economics* / Q000453:epidemiology; D064804:Urological Agents / Q000191:economics / Q000627:therapeutic use
chemical_list: D001559:Benzhydryl Compounds; D018678:Cholinergic Agents; D003408:Cresols; D011812:Quinuclidines; D044005:Tetrahydroisoquinolines; D064804:Urological Agents; D010665:Phenylpropanolamine; D000068737:Tolterodine Tartrate; C526675:fesoterodine; D000069464:Solifenacin Succinate