title: Economic evaluation of pharmacological treatments for overactive bladder from the perspective of the UK National Health Service.
abstract: OBJECTIVE
  To evaluate the costs and outcomes associated with different sequences of oral anti-muscarinic agents and the selective β(3)-adrenoceptor agonist, mirabegron, for the treatment of overactive bladder (OAB).
  
  
  METHODS
  A Markov model with monthly cycle length and time horizon up to 3 years was designed to compare two different sequences of up to three lines of oral therapy for OAB. Patients who discontinued one oral medication could switch to another oral medication or could discontinue treatment. Patients whose symptoms were not controlled were considered for botulinum toxin or sacral nerve stimulation. Outcomes were measured by (a) number of patients with controlled symptoms (no incontinence episodes and <8 micturitions per 24 h); (b) patients with no incontinence episodes per 24 hours; and (c) patients with <8 micturitions per 24 h.
  
  
  RESULTS
  Including a third-line oral medication before considering other treatment options improved all patient outcomes, irrespective of the specific drugs used. A three-line sequence including two generic (oxybutynin first line and tolterodine extended-release second line) and one branded drug (solifenacin 5 mg third line) resulted in inferior patient outcomes at costs similar to a sequence of branded drugs (mirabegron first line, solifenacin 5 mg second line, solifenacin 10 mg third line): controlled patients (generic 29.6/1000 vs branded 38.7/1000); patients with no incontinence episodes (103.6/1000 vs 123.7/1000); patients with <8 micturitions (228.7/1000 vs 262.1/1000). Annual treatment costs per patient were similar (generic £1299 vs branded £1385).
  
  
  CONCLUSIONS
  In the treatment of OAB, low-cost generic treatments are not necessarily more cost-effective than branded drugs, primarily because a better efficacy and tolerability balance improves both symptom control and persistence.
authors.affiliation: Astellas Pharma Europe Ltd , Chertsey , UK.
authors.forename: Jameel
authors.initials: J
authors.lastname: Nazir
authors.forename: John
authors.initials: J
authors.lastname: Posnett
authors.forename: Anna
authors.initials: A
authors.lastname: Walker
authors.forename: Isaac A
authors.initials: IA
authors.lastname: Odeyemi
authors.forename: Zalmai
authors.initials: Z
authors.lastname: Hakimi
authors.forename: Andrew
authors.initials: A
authors.lastname: Garnham
mesh_terms: D000083:Acetanilides / Q000191:economics* / Q000627:therapeutic use; D058667:Adrenergic beta-3 Receptor Agonists / Q000191:economics* / Q000627:therapeutic use; D003362:Cost-Benefit Analysis; D006296:Health Services / Q000191:economics / Q000706:statistics & numerical data; D006801:Humans; D008390:Markov Chains; D018727:Muscarinic Antagonists / Q000191:economics* / Q000627:therapeutic use; D009313:National Health Programs; D013844:Thiazoles / Q000191:economics* / Q000627:therapeutic use; D006113:United Kingdom; D053201:Urinary Bladder, Overactive / Q000188:drug therapy*; D064804:Urological Agents / Q000191:economics* / Q000627:therapeutic use
chemical_list: D000083:Acetanilides; D058667:Adrenergic beta-3 Receptor Agonists; D018727:Muscarinic Antagonists; D013844:Thiazoles; D064804:Urological Agents; C520025:mirabegron
keywords: Anti-muscarinic agents; Markov model; Mirabegron; Overactive bladder; Pharmacoeconomics