Cost-effectiveness analysis of solifenacin versus oxybutynin immediate-release in the treatment of patients with overactive bladder in the United Kingdom
Abstract Objective: To carry out a cost-utility analysis comparing initial treatment with solifenacin 5 mg/day vs oxybutynin immediate-release (IR) 15 mg/day for the treatment of patients with overactive bladder (OAB) from the perspective of the UK National Health Service (NHS). Methods: A Markov mo...
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| Veröffentlicht in: | Journal of medical economics 2013-10, Vol.16 (10), p.1246-1254 |
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| creator | Hart, Warren Mark Abrams, Paul Munro, Vicki Retsa, Peny Nazir, Jameel |
| description | Abstract
Objective:
To carry out a cost-utility analysis comparing initial treatment with solifenacin 5 mg/day vs oxybutynin immediate-release (IR) 15 mg/day for the treatment of patients with overactive bladder (OAB) from the perspective of the UK National Health Service (NHS).
Methods:
A Markov model with six health states was developed to follow a cohort of OAB patients treated with either solifenacin or oxybutynin during a 1-year period. Costs and utilities were accumulated as patients transited through the health states in the model and a drop-out state. Some of the solifenacin patients were titrated from 5 mg to 10 mg/day at 8 weeks. A proportion of drop-out patients were assumed to continue treatment with tolterodine ER. Utility values were obtained from a Swedish study and pad use was based on a multinational clinical trial. Adherence rates for individual treatments were derived from a UK database study. For pad use and utility values, the drop-out state was split between those patients who were no longer receiving treatment and those on second-line therapy. Patients on second-line therapy who drop-out were referred for a specialist visit. Results were expressed in terms of incremental cost-utility ratios.
Results:
Total annual costs for solifenacin and oxybutynin were £504.30 and £364.19, respectively. First-line drug use represents 49% and 4% of costs and pad use represent 23% and 40% of costs for solifenacin and oxybutynin, respectively. Differences between cumulative utilities were small but were greater for solifenacin (0.7020 vs 0.6907). The baseline incremental cost-effectiveness ratio was £12,309/QALY.
Conclusion:
Under the baseline assumptions, solifenacin would appear to be cost-effective with an incremental cost-utility of less than £20,000/QALY. However, small differences in utility between the alternatives and the large number of drop-outs means that the results are sensitive to small adjustments in the values of utilities assigned to the drop-out state. |
| doi_str_mv | 10.3111/13696998.2013.829079 |
| format | Article |
| fullrecord | <record><control><sourceid>proquest_cross</sourceid><recordid>TN_cdi_crossref_primary_10_3111_13696998_2013_829079</recordid><sourceformat>XML</sourceformat><sourcesystem>PC</sourcesystem><sourcerecordid>1435846743</sourcerecordid><originalsourceid>FETCH-LOGICAL-c3799-c75239104d382ea53347442fa5c991ef99c7119806bf1f75230eddb7267695ad3</originalsourceid><addsrcrecordid>eNp9kc1u1DAUhSMEolXpGyDkJZsMcZzE8QaERuVHVGJDJXbWjX3NuHLswXZa5lF4Wxymg8Sm3vjq6LvnWD5V9ZI2G0YpfUPZIAYhxk3bULYZW9Fw8aQ6p6Kj9cj496dlLki9MmfVZUq3TTmM0YbT59VZy8axH4bmvPq9DSnXaAyqbO_QY0oEPLhDsokEQ1Jw1qAHZT25w5iWov46TEs--KLYeUZtIWMd0SEkJEXMOyQ5IuQZfV499pBtGRO5t3lHQrGBv2FkcqA1xtPSjbcZNfli_Q8d5hfVMwMu4eXDfVHdfLj6tv1UX3_9-Hn7_rpWjAtRK963TNCm02xsEXrGOt51rYFeCUHRCKE4pWJshslQs8INaj3xduCD6EGzi-r10Xcfw88FU5azTQqdA49hSZJ2rB-7gXesoN0RVTGkFNHIfbQzxIOkjVx7kade5NqLPPZS1l49JCxT-a9_S6cWCvDuCFhvQpzhPkSnZYaDC9FE8MqmYv94xNv_HHYILu8URJS3YYml0PT4G_8AKdey5Q</addsrcrecordid><sourcetype>Aggregation Database</sourcetype><iscdi>true</iscdi><recordtype>article</recordtype><pqid>1435846743</pqid></control><display><type>article</type><title>Cost-effectiveness analysis of solifenacin versus oxybutynin immediate-release in the treatment of patients with overactive bladder in the United Kingdom</title><source>MEDLINE</source><source>Elektronische Zeitschriftenbibliothek - Frei zugängliche E-Journals</source><creator>Hart, Warren Mark ; Abrams, Paul ; Munro, Vicki ; Retsa, Peny ; Nazir, Jameel</creator><creatorcontrib>Hart, Warren Mark ; Abrams, Paul ; Munro, Vicki ; Retsa, Peny ; Nazir, Jameel</creatorcontrib><description>Abstract
Objective:
To carry out a cost-utility analysis comparing initial treatment with solifenacin 5 mg/day vs oxybutynin immediate-release (IR) 15 mg/day for the treatment of patients with overactive bladder (OAB) from the perspective of the UK National Health Service (NHS).
Methods:
A Markov model with six health states was developed to follow a cohort of OAB patients treated with either solifenacin or oxybutynin during a 1-year period. Costs and utilities were accumulated as patients transited through the health states in the model and a drop-out state. Some of the solifenacin patients were titrated from 5 mg to 10 mg/day at 8 weeks. A proportion of drop-out patients were assumed to continue treatment with tolterodine ER. Utility values were obtained from a Swedish study and pad use was based on a multinational clinical trial. Adherence rates for individual treatments were derived from a UK database study. For pad use and utility values, the drop-out state was split between those patients who were no longer receiving treatment and those on second-line therapy. Patients on second-line therapy who drop-out were referred for a specialist visit. Results were expressed in terms of incremental cost-utility ratios.
Results:
Total annual costs for solifenacin and oxybutynin were £504.30 and £364.19, respectively. First-line drug use represents 49% and 4% of costs and pad use represent 23% and 40% of costs for solifenacin and oxybutynin, respectively. Differences between cumulative utilities were small but were greater for solifenacin (0.7020 vs 0.6907). The baseline incremental cost-effectiveness ratio was £12,309/QALY.
Conclusion:
Under the baseline assumptions, solifenacin would appear to be cost-effective with an incremental cost-utility of less than £20,000/QALY. However, small differences in utility between the alternatives and the large number of drop-outs means that the results are sensitive to small adjustments in the values of utilities assigned to the drop-out state.</description><identifier>ISSN: 1369-6998</identifier><identifier>EISSN: 1941-837X</identifier><identifier>DOI: 10.3111/13696998.2013.829079</identifier><identifier>PMID: 23885660</identifier><language>eng</language><publisher>England: Informa UK Ltd</publisher><subject><![CDATA[Benzhydryl Compounds - administration & dosage ; Benzhydryl Compounds - adverse effects ; Benzhydryl Compounds - economics ; Cohort Studies ; Cost ; Cost-Benefit Analysis ; Cresols - administration & dosage ; Cresols - adverse effects ; Cresols - economics ; Humans ; Incontinence Pads - economics ; Incontinence Pads - statistics & numerical data ; Mandelic Acids - administration & dosage ; Mandelic Acids - adverse effects ; Mandelic Acids - economics ; Markov Chains ; Medication Adherence - statistics & numerical data ; Models, Economic ; Muscarinic Antagonists - administration & dosage ; Muscarinic Antagonists - adverse effects ; Muscarinic Antagonists - economics ; Overactive bladder ; Oxybutynin ; Patient Dropouts - statistics & numerical data ; Phenylpropanolamine - administration & dosage ; Phenylpropanolamine - adverse effects ; Phenylpropanolamine - economics ; Quality-Adjusted Life Years ; Quinuclidines - administration & dosage ; Quinuclidines - adverse effects ; Quinuclidines - economics ; Solifenacin ; Solifenacin Succinate ; Tetrahydroisoquinolines - administration & dosage ; Tetrahydroisoquinolines - adverse effects ; Tetrahydroisoquinolines - economics ; Tolterodine Tartrate ; Treatment Outcome ; United Kingdom ; Urinary Bladder, Overactive - complications ; Urinary Bladder, Overactive - drug therapy ; Urinary Bladder, Overactive - economics ; Urinary Incontinence - drug therapy ; Urinary Incontinence - economics ; Urinary Incontinence - etiology ; Utility]]></subject><ispartof>Journal of medical economics, 2013-10, Vol.16 (10), p.1246-1254</ispartof><rights>2013 All rights reserved: reproduction in whole or part not permitted 2013</rights><lds50>peer_reviewed</lds50><oa>free_for_read</oa><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c3799-c75239104d382ea53347442fa5c991ef99c7119806bf1f75230eddb7267695ad3</citedby><cites>FETCH-LOGICAL-c3799-c75239104d382ea53347442fa5c991ef99c7119806bf1f75230eddb7267695ad3</cites></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><link.rule.ids>314,776,780,27901,27902</link.rule.ids><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/23885660$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Hart, Warren Mark</creatorcontrib><creatorcontrib>Abrams, Paul</creatorcontrib><creatorcontrib>Munro, Vicki</creatorcontrib><creatorcontrib>Retsa, Peny</creatorcontrib><creatorcontrib>Nazir, Jameel</creatorcontrib><title>Cost-effectiveness analysis of solifenacin versus oxybutynin immediate-release in the treatment of patients with overactive bladder in the United Kingdom</title><title>Journal of medical economics</title><addtitle>J Med Econ</addtitle><description>Abstract
Objective:
To carry out a cost-utility analysis comparing initial treatment with solifenacin 5 mg/day vs oxybutynin immediate-release (IR) 15 mg/day for the treatment of patients with overactive bladder (OAB) from the perspective of the UK National Health Service (NHS).
Methods:
A Markov model with six health states was developed to follow a cohort of OAB patients treated with either solifenacin or oxybutynin during a 1-year period. Costs and utilities were accumulated as patients transited through the health states in the model and a drop-out state. Some of the solifenacin patients were titrated from 5 mg to 10 mg/day at 8 weeks. A proportion of drop-out patients were assumed to continue treatment with tolterodine ER. Utility values were obtained from a Swedish study and pad use was based on a multinational clinical trial. Adherence rates for individual treatments were derived from a UK database study. For pad use and utility values, the drop-out state was split between those patients who were no longer receiving treatment and those on second-line therapy. Patients on second-line therapy who drop-out were referred for a specialist visit. Results were expressed in terms of incremental cost-utility ratios.
Results:
Total annual costs for solifenacin and oxybutynin were £504.30 and £364.19, respectively. First-line drug use represents 49% and 4% of costs and pad use represent 23% and 40% of costs for solifenacin and oxybutynin, respectively. Differences between cumulative utilities were small but were greater for solifenacin (0.7020 vs 0.6907). The baseline incremental cost-effectiveness ratio was £12,309/QALY.
Conclusion:
Under the baseline assumptions, solifenacin would appear to be cost-effective with an incremental cost-utility of less than £20,000/QALY. However, small differences in utility between the alternatives and the large number of drop-outs means that the results are sensitive to small adjustments in the values of utilities assigned to the drop-out state.</description><subject>Benzhydryl Compounds - administration & dosage</subject><subject>Benzhydryl Compounds - adverse effects</subject><subject>Benzhydryl Compounds - economics</subject><subject>Cohort Studies</subject><subject>Cost</subject><subject>Cost-Benefit Analysis</subject><subject>Cresols - administration & dosage</subject><subject>Cresols - adverse effects</subject><subject>Cresols - economics</subject><subject>Humans</subject><subject>Incontinence Pads - economics</subject><subject>Incontinence Pads - statistics & numerical data</subject><subject>Mandelic Acids - administration & dosage</subject><subject>Mandelic Acids - adverse effects</subject><subject>Mandelic Acids - economics</subject><subject>Markov Chains</subject><subject>Medication Adherence - statistics & numerical data</subject><subject>Models, Economic</subject><subject>Muscarinic Antagonists - administration & dosage</subject><subject>Muscarinic Antagonists - adverse effects</subject><subject>Muscarinic Antagonists - economics</subject><subject>Overactive bladder</subject><subject>Oxybutynin</subject><subject>Patient Dropouts - statistics & numerical data</subject><subject>Phenylpropanolamine - administration & dosage</subject><subject>Phenylpropanolamine - adverse effects</subject><subject>Phenylpropanolamine - economics</subject><subject>Quality-Adjusted Life Years</subject><subject>Quinuclidines - administration & dosage</subject><subject>Quinuclidines - adverse effects</subject><subject>Quinuclidines - economics</subject><subject>Solifenacin</subject><subject>Solifenacin Succinate</subject><subject>Tetrahydroisoquinolines - administration & dosage</subject><subject>Tetrahydroisoquinolines - adverse effects</subject><subject>Tetrahydroisoquinolines - economics</subject><subject>Tolterodine Tartrate</subject><subject>Treatment Outcome</subject><subject>United Kingdom</subject><subject>Urinary Bladder, Overactive - complications</subject><subject>Urinary Bladder, Overactive - drug therapy</subject><subject>Urinary Bladder, Overactive - economics</subject><subject>Urinary Incontinence - drug therapy</subject><subject>Urinary Incontinence - economics</subject><subject>Urinary Incontinence - etiology</subject><subject>Utility</subject><issn>1369-6998</issn><issn>1941-837X</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2013</creationdate><recordtype>article</recordtype><sourceid>EIF</sourceid><recordid>eNp9kc1u1DAUhSMEolXpGyDkJZsMcZzE8QaERuVHVGJDJXbWjX3NuHLswXZa5lF4Wxymg8Sm3vjq6LvnWD5V9ZI2G0YpfUPZIAYhxk3bULYZW9Fw8aQ6p6Kj9cj496dlLki9MmfVZUq3TTmM0YbT59VZy8axH4bmvPq9DSnXaAyqbO_QY0oEPLhDsokEQ1Jw1qAHZT25w5iWov46TEs--KLYeUZtIWMd0SEkJEXMOyQ5IuQZfV499pBtGRO5t3lHQrGBv2FkcqA1xtPSjbcZNfli_Q8d5hfVMwMu4eXDfVHdfLj6tv1UX3_9-Hn7_rpWjAtRK963TNCm02xsEXrGOt51rYFeCUHRCKE4pWJshslQs8INaj3xduCD6EGzi-r10Xcfw88FU5azTQqdA49hSZJ2rB-7gXesoN0RVTGkFNHIfbQzxIOkjVx7kade5NqLPPZS1l49JCxT-a9_S6cWCvDuCFhvQpzhPkSnZYaDC9FE8MqmYv94xNv_HHYILu8URJS3YYml0PT4G_8AKdey5Q</recordid><startdate>201310</startdate><enddate>201310</enddate><creator>Hart, Warren Mark</creator><creator>Abrams, Paul</creator><creator>Munro, Vicki</creator><creator>Retsa, Peny</creator><creator>Nazir, Jameel</creator><general>Informa UK Ltd</general><general>Taylor & Francis</general><scope>CGR</scope><scope>CUY</scope><scope>CVF</scope><scope>ECM</scope><scope>EIF</scope><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope><scope>7X8</scope></search><sort><creationdate>201310</creationdate><title>Cost-effectiveness analysis of solifenacin versus oxybutynin immediate-release in the treatment of patients with overactive bladder in the United Kingdom</title><author>Hart, Warren Mark ; Abrams, Paul ; Munro, Vicki ; Retsa, Peny ; Nazir, Jameel</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c3799-c75239104d382ea53347442fa5c991ef99c7119806bf1f75230eddb7267695ad3</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2013</creationdate><topic>Benzhydryl Compounds - administration & dosage</topic><topic>Benzhydryl Compounds - adverse effects</topic><topic>Benzhydryl Compounds - economics</topic><topic>Cohort Studies</topic><topic>Cost</topic><topic>Cost-Benefit Analysis</topic><topic>Cresols - administration & dosage</topic><topic>Cresols - adverse effects</topic><topic>Cresols - economics</topic><topic>Humans</topic><topic>Incontinence Pads - economics</topic><topic>Incontinence Pads - statistics & numerical data</topic><topic>Mandelic Acids - administration & dosage</topic><topic>Mandelic Acids - adverse effects</topic><topic>Mandelic Acids - economics</topic><topic>Markov Chains</topic><topic>Medication Adherence - statistics & numerical data</topic><topic>Models, Economic</topic><topic>Muscarinic Antagonists - administration & dosage</topic><topic>Muscarinic Antagonists - adverse effects</topic><topic>Muscarinic Antagonists - economics</topic><topic>Overactive bladder</topic><topic>Oxybutynin</topic><topic>Patient Dropouts - statistics & numerical data</topic><topic>Phenylpropanolamine - administration & dosage</topic><topic>Phenylpropanolamine - adverse effects</topic><topic>Phenylpropanolamine - economics</topic><topic>Quality-Adjusted Life Years</topic><topic>Quinuclidines - administration & dosage</topic><topic>Quinuclidines - adverse effects</topic><topic>Quinuclidines - economics</topic><topic>Solifenacin</topic><topic>Solifenacin Succinate</topic><topic>Tetrahydroisoquinolines - administration & dosage</topic><topic>Tetrahydroisoquinolines - adverse effects</topic><topic>Tetrahydroisoquinolines - economics</topic><topic>Tolterodine Tartrate</topic><topic>Treatment Outcome</topic><topic>United Kingdom</topic><topic>Urinary Bladder, Overactive - complications</topic><topic>Urinary Bladder, Overactive - drug therapy</topic><topic>Urinary Bladder, Overactive - economics</topic><topic>Urinary Incontinence - drug therapy</topic><topic>Urinary Incontinence - economics</topic><topic>Urinary Incontinence - etiology</topic><topic>Utility</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Hart, Warren Mark</creatorcontrib><creatorcontrib>Abrams, Paul</creatorcontrib><creatorcontrib>Munro, Vicki</creatorcontrib><creatorcontrib>Retsa, Peny</creatorcontrib><creatorcontrib>Nazir, Jameel</creatorcontrib><collection>Medline</collection><collection>MEDLINE</collection><collection>MEDLINE (Ovid)</collection><collection>MEDLINE</collection><collection>MEDLINE</collection><collection>PubMed</collection><collection>CrossRef</collection><collection>MEDLINE - Academic</collection><jtitle>Journal of medical economics</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Hart, Warren Mark</au><au>Abrams, Paul</au><au>Munro, Vicki</au><au>Retsa, Peny</au><au>Nazir, Jameel</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Cost-effectiveness analysis of solifenacin versus oxybutynin immediate-release in the treatment of patients with overactive bladder in the United Kingdom</atitle><jtitle>Journal of medical economics</jtitle><addtitle>J Med Econ</addtitle><date>2013-10</date><risdate>2013</risdate><volume>16</volume><issue>10</issue><spage>1246</spage><epage>1254</epage><pages>1246-1254</pages><issn>1369-6998</issn><eissn>1941-837X</eissn><abstract>Abstract
Objective:
To carry out a cost-utility analysis comparing initial treatment with solifenacin 5 mg/day vs oxybutynin immediate-release (IR) 15 mg/day for the treatment of patients with overactive bladder (OAB) from the perspective of the UK National Health Service (NHS).
Methods:
A Markov model with six health states was developed to follow a cohort of OAB patients treated with either solifenacin or oxybutynin during a 1-year period. Costs and utilities were accumulated as patients transited through the health states in the model and a drop-out state. Some of the solifenacin patients were titrated from 5 mg to 10 mg/day at 8 weeks. A proportion of drop-out patients were assumed to continue treatment with tolterodine ER. Utility values were obtained from a Swedish study and pad use was based on a multinational clinical trial. Adherence rates for individual treatments were derived from a UK database study. For pad use and utility values, the drop-out state was split between those patients who were no longer receiving treatment and those on second-line therapy. Patients on second-line therapy who drop-out were referred for a specialist visit. Results were expressed in terms of incremental cost-utility ratios.
Results:
Total annual costs for solifenacin and oxybutynin were £504.30 and £364.19, respectively. First-line drug use represents 49% and 4% of costs and pad use represent 23% and 40% of costs for solifenacin and oxybutynin, respectively. Differences between cumulative utilities were small but were greater for solifenacin (0.7020 vs 0.6907). The baseline incremental cost-effectiveness ratio was £12,309/QALY.
Conclusion:
Under the baseline assumptions, solifenacin would appear to be cost-effective with an incremental cost-utility of less than £20,000/QALY. However, small differences in utility between the alternatives and the large number of drop-outs means that the results are sensitive to small adjustments in the values of utilities assigned to the drop-out state.</abstract><cop>England</cop><pub>Informa UK Ltd</pub><pmid>23885660</pmid><doi>10.3111/13696998.2013.829079</doi><tpages>9</tpages><oa>free_for_read</oa></addata></record> |
| fulltext | fulltext |
| identifier | ISSN: 1369-6998 |
| ispartof | Journal of medical economics, 2013-10, Vol.16 (10), p.1246-1254 |
| issn | 1369-6998 1941-837X |
| language | eng |
| recordid | cdi_crossref_primary_10_3111_13696998_2013_829079 |
| source | MEDLINE; Elektronische Zeitschriftenbibliothek - Frei zugängliche E-Journals |
| subjects | Benzhydryl Compounds - administration & dosage Benzhydryl Compounds - adverse effects Benzhydryl Compounds - economics Cohort Studies Cost Cost-Benefit Analysis Cresols - administration & dosage Cresols - adverse effects Cresols - economics Humans Incontinence Pads - economics Incontinence Pads - statistics & numerical data Mandelic Acids - administration & dosage Mandelic Acids - adverse effects Mandelic Acids - economics Markov Chains Medication Adherence - statistics & numerical data Models, Economic Muscarinic Antagonists - administration & dosage Muscarinic Antagonists - adverse effects Muscarinic Antagonists - economics Overactive bladder Oxybutynin Patient Dropouts - statistics & numerical data Phenylpropanolamine - administration & dosage Phenylpropanolamine - adverse effects Phenylpropanolamine - economics Quality-Adjusted Life Years Quinuclidines - administration & dosage Quinuclidines - adverse effects Quinuclidines - economics Solifenacin Solifenacin Succinate Tetrahydroisoquinolines - administration & dosage Tetrahydroisoquinolines - adverse effects Tetrahydroisoquinolines - economics Tolterodine Tartrate Treatment Outcome United Kingdom Urinary Bladder, Overactive - complications Urinary Bladder, Overactive - drug therapy Urinary Bladder, Overactive - economics Urinary Incontinence - drug therapy Urinary Incontinence - economics Urinary Incontinence - etiology Utility |
| title | Cost-effectiveness analysis of solifenacin versus oxybutynin immediate-release in the treatment of patients with overactive bladder in the United Kingdom |
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