Updated Budget Impact Analysis of Vibegron for the Treatment of Overactive Bladder in the United States
Author(s)
Ian Gould, PhD1, Jeff Lee, PharmD1, Jeffrey Nesheim, PharmD, MS2, Adam Carrera, PharmD2;
1Lumanity, Inc., Morristown, NJ, USA, 2Sumitomo Pharma America, Inc., Marlborough, MA, USA
1Lumanity, Inc., Morristown, NJ, USA, 2Sumitomo Pharma America, Inc., Marlborough, MA, USA
OBJECTIVES: A previously developed budget impact model (BIM) showed that introducing vibegron, a β3-adrenergic receptor agonist for overactive bladder (OAB), to US commercial and Medicare health plans was associated with modest increases in per-patient per-month (PMPM) costs that were partially offset by savings related to improved outcomes and reduced use of other treatments. This updated analysis assesses the impact of recent developments, including generic mirabegron and newly uncovered cost and clinical outcomes associated with anticholinergic burden (ACB) in patients with OAB.
METHODS: A BIM was developed with a 5-year time horizon, using projected market shares for 1-million member US commercial and Medicare plans and a top-down prevalence-based approach. The BIM included vibegron, branded and generic mirabegron, and anticholinergics and incorporated changes in outcomes including efficacy (mean daily incontinence episodes), ACB, OAB-related comorbidities, adverse events (AEs), minimally invasive treatment costs, drug-drug interactions, and treatment persistence. Economic outcomes are projected as costs PMPM and per-treated member per-month (PTMPM).
RESULTS: Adding vibegron to a health plan formulary was associated with a moderate increase in PMPM cost over 5 years of $0.95 (range for years 1‒5, $0.56‒$1.28) for commercial payors and $1.86 ($1.08‒$2.55) for Medicare and in PTMPM cost of $24.50 (range for years 1‒5, $15.12‒$31.65) and $26.93 ($16.11‒$35.29), respectively. Costs were partially offset by reduced ACB-related cognitive impairment, cardiovascular risks, and falls/fractures totaling over $16 and $25 million USD in 5 years for commercial and Medicare payors, respectively. Other major cost-offsets included those for minimally invasive treatment ($6.5 million, $6.5 million) and disease-related comorbidity ($1 million, $1.3 million).
CONCLUSIONS: Vibegron continues to have modest budget impact to health plans despite introduction of generic mirabegron. Improved outcomes and reduced costs associated with decreased ACB and fewer drug-drug interactions may partially offset increased pharmacy costs.
METHODS: A BIM was developed with a 5-year time horizon, using projected market shares for 1-million member US commercial and Medicare plans and a top-down prevalence-based approach. The BIM included vibegron, branded and generic mirabegron, and anticholinergics and incorporated changes in outcomes including efficacy (mean daily incontinence episodes), ACB, OAB-related comorbidities, adverse events (AEs), minimally invasive treatment costs, drug-drug interactions, and treatment persistence. Economic outcomes are projected as costs PMPM and per-treated member per-month (PTMPM).
RESULTS: Adding vibegron to a health plan formulary was associated with a moderate increase in PMPM cost over 5 years of $0.95 (range for years 1‒5, $0.56‒$1.28) for commercial payors and $1.86 ($1.08‒$2.55) for Medicare and in PTMPM cost of $24.50 (range for years 1‒5, $15.12‒$31.65) and $26.93 ($16.11‒$35.29), respectively. Costs were partially offset by reduced ACB-related cognitive impairment, cardiovascular risks, and falls/fractures totaling over $16 and $25 million USD in 5 years for commercial and Medicare payors, respectively. Other major cost-offsets included those for minimally invasive treatment ($6.5 million, $6.5 million) and disease-related comorbidity ($1 million, $1.3 million).
CONCLUSIONS: Vibegron continues to have modest budget impact to health plans despite introduction of generic mirabegron. Improved outcomes and reduced costs associated with decreased ACB and fewer drug-drug interactions may partially offset increased pharmacy costs.
Conference/Value in Health Info
2025-05, ISPOR 2025, Montréal, Quebec, CA
Value in Health, Volume 28, Issue S1
Code
EE108
Topic
Economic Evaluation
Topic Subcategory
Budget Impact Analysis
Disease
SDC: Urinary/Kidney Disorders