title: Cost effectiveness of fesoterodine and tolterodine for the treatment of overactive bladder with urge urinary incontinence in Spain and Finland.
abstract: BACKGROUND
  Overactive bladder is a prevalent condition worldwide that is associated with a considerable burden, both on the patient and on society.
  
  
  OBJECTIVE
  Our objective was to assess the economic value of fesoterodine compared with tolterodine extended release (ER) for the treatment of overactive bladder (OAB) with urge urinary incontinence (UUI) in Spain and Finland.
  
  
  METHODS
  A decision-tree economic model estimated the 52-week costs and quality-adjusted life-years (QALYs) of OAB/UUI patients initiating treatment with fesoterodine 4 mg/day or tolterodine ER. Individuals were evaluated for treatment response (UUI fewer than one episode/day) and persistence at weeks 4, 12, and 24. Titration from fesoterodine 4 mg/day to 8 mg/day was permitted at week 4. At week 12, non-responders discontinued treatment permanently. Efficacy, discontinuation, and utility data were derived from four clinical trials of fesoterodine. OAB-related costs, including physician visits, laboratory tests, incontinence pads, and comorbidities (fracture, skin infection, urinary tract infections, depression, and nursing home) were also included.
  
  
  RESULTS
  A total of 19.5 % and 18.0 % of fesoterodine and tolterodine ER patients remained on treatment until week 52, respectively. QALYs were higher with fesoterodine than tolterodine ER (0.762 vs. 0.760). In Spain, fesoterodine treatment had higher total costs than (generic) tolterodine ER (€6,697 vs. 6,597), resulting in a cost of €15,633/QALY gained. In Finland, fesoterodine was cost saving relative to (non-generic) tolterodine ER (€7,885 vs. 8,024). Sensitivity analysis confirmed that these findings were robust to the expected price decrease for generic tolterodine ER in Finland.
  
  
  CONCLUSIONS
  Fesoterodine is cost effective or cost saving relative to tolterodine ER for the treatment of OAB with UUI in two European countries. Payers and prescribers should consider a broad scope of costs to make informed cost-conscious choices of antimuscarinic treatment.
authors.affiliation: Servicio de Urología, Hospital Universitario de Getafe, Crta Madrid-Toledo km 12,5, 28905, Getafe (Madrid), Spain, jangulo.hugf@salud.madrid.org.
authors.forename: Javier C
authors.initials: JC
authors.lastname: Angulo
authors.forename: Antti
authors.initials: A
authors.lastname: Valpas
authors.forename: Javier
authors.initials: J
authors.lastname: Rejas
authors.forename: Kari
authors.initials: K
authors.lastname: Linden
authors.forename: Marion
authors.initials: M
authors.lastname: Kvasz
authors.forename: Sonya J
authors.initials: SJ
authors.lastname: Snedecor
mesh_terms: D001559:Benzhydryl Compounds / Q000191:economics* / Q000627:therapeutic use*; D003362:Cost-Benefit Analysis; D003408:Cresols / Q000191:economics* / Q000627:therapeutic use*; D005387:Finland; D006801:Humans; D010665:Phenylpropanolamine / Q000191:economics* / Q000627:therapeutic use*; D013030:Spain; D000068737:Tolterodine Tartrate; D053201:Urinary Bladder, Overactive / Q000188:drug therapy*; D053202:Urinary Incontinence, Urge / Q000188:drug therapy*
chemical_list: D001559:Benzhydryl Compounds; D003408:Cresols; D010665:Phenylpropanolamine; D000068737:Tolterodine Tartrate; C526675:fesoterodine