title: Cost effectiveness analysis of fesoterodine compared to mirabegron in first-line therapy setting for overactive bladder with urge urinary incontinence, from the Spanish National Health System perspective.
abstract: OBJECTIVE
  To evaluate the cost-effectiveness of first-line treatment of Overactive Bladder (OAB) with fesoterodine relative to mirabegron, from the Spanish National Health System (NHS) perspective.
  
  
  METHODS
  A decision tree model was developed to represent a typical clinical process of 52-week of treatment for an OAB patient with urge urinary incontinence (UUI) initiating first-line therapy with fesoterodine 4mg, including optional titration to 8mg, vs.mirabegron 50mg. Efficacy data were obtained from a Bayesian indirect treatment meta-analysis. Patients with UUI of less than one episode/day were defined as treatment responder and persistence was assessed at weeks 4, 12 and 24. At week 12, non-responders discontinued treatment permanently. Quality-adjusted life years (QALYs) were calculated based on time spent in responder and non-responder states. OAB-related drug and medical care costs including physician visits, laboratory tests, incontinence pads, and comorbidities (fracture, skin infection, urinary tract infections and depression) were modeled and expressed in €2015.
  
  
  RESULTS
  At week 52, the percentage of responders was 20.8% for patients starting on fesoterodine 4mg who optionally titrated to 8mg and 19.4% for patients treated with mirabegron. QALYs were slightly higher with fesoterodine than mirabegron (0.7703vs. 0.7668, difference=0.0035). Fesoterodine treatment also had slightly higher total costs than mirabegron (3,296€vs. 3,217, difference=79€), resulting in a cost of 22,523/QALY€ gained for fesoterodine versus mirabegron. Probabilistic sensitivity analysis confirmed the slight advantage of fesoterodine with a 61.1% probability of being cost-effective at the 30,000€ willingness-to-pay for 1QALY threshold.
  
  
  CONCLUSIONS
  Given the relatively small 1-year cost difference between the two treatments, fesoterodine can be considered a cost-effective option relative to mirabegron for the first-line management of OAB with UUI in Spain.
authors.affiliation: Departamento Clínico, Universidad Europea de Madrid, Servicio de Urología, Hospital Universitario de Getafe, Getafe, Madrid, España. Electronic address: jangulo@futurnet.es.
authors.forename: J C
authors.initials: JC
authors.lastname: Angulo
authors.affiliation: Servicio de Urología, Hospital General Universitario de Valencia, Valencia, España.
authors.forename: F
authors.initials: F
authors.lastname: Sánchez-Ballester
authors.affiliation: Health Economics and Outcomes Research. Pfizer SLU , Alcobendas, Madrid, España.
authors.forename: C
authors.initials: C
authors.lastname: Peral
authors.affiliation: Health Economics and Outcomes Research. Pfizer SLU , Alcobendas, Madrid, España.
authors.forename: J
authors.initials: J
authors.lastname: Rejas
authors.affiliation: Health Economics and Outcomes Research. Pfizer SLU , Alcobendas, Madrid, España.
authors.forename: J
authors.initials: J
authors.lastname: Ramos
authors.affiliation: Pharmerit, Bethesda, Maryland, Estados Unidos.
authors.forename: S J
authors.initials: SJ
authors.lastname: Snedecor
authors.affiliation: Pharmerit, Bethesda, Maryland, Estados Unidos.
authors.forename: L
authors.initials: L
authors.lastname: Sudharshan
authors.affiliation: Pharmerit, Bethesda, Maryland, Estados Unidos.
authors.forename: S
authors.initials: S
authors.lastname: Liu
authors.affiliation: Outcomes and Evidence, Pfizer Inc, Groton, Connecticut, Estados Unidos.
authors.forename: X
authors.initials: X
authors.lastname: Luo
mesh_terms: D000083:Acetanilides / Q000191:economics* / Q000627:therapeutic use*; D001559:Benzhydryl Compounds / Q000191:economics* / Q000627:therapeutic use*; D003362:Cost-Benefit Analysis; D003695:Delivery of Health Care; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D013030:Spain; D013844:Thiazoles / Q000191:economics* / Q000627:therapeutic use*; D053201:Urinary Bladder, Overactive / Q000150:complications / Q000188:drug therapy* / Q000191:economics*; D053202:Urinary Incontinence, Urge / Q000150:complications / Q000188:drug therapy* / Q000191:economics*
chemical_list: D000083:Acetanilides; D001559:Benzhydryl Compounds; D013844:Thiazoles; C526675:fesoterodine; C520025:mirabegron
keywords: Análisis de coste efectividad; Cost-effectiveness analysis; Economic model; Fesoterodina; Fesoterodine; Mirabegron; Modelo económico