OBJECTIVES: To evaluate the cost effectiveness of vibegron compared with other oral pharmacologic therapies as first-line treatment for overactive bladder (OAB).

METHODS: A semi-Markov model with monthly cycles was developed to support a lifetime horizon of vibegron 75 mg from a US commercial payor or Medicare perspective. The model incorporated efficacy (daily number of micturitions and incontinence episodes), adverse events (AEs), OAB-related comorbidities, drug-drug interactions, anticholinergic burden, and treatment persistence. The base case employed a lifetime horizon and excluded indirect costs. Costs and quality-adjusted life years (QALY) were accumulated over time. The primary outcome was the cost per QALY incremental cost-effectiveness ratio (ICER). One-way (OWSA) and probabilistic (PSA) sensitivity analyses were performed to evaluate the impact of changes in key variables.

RESULTS: For commercial payors, vibegron was cost effective at a willingness-to-pay (WTP) threshold of $50,000/QALY compared with mirabegron 50 mg (ICER, $9,311) and at a WTP threshold of $150,000/QALY compared with mirabegron 25 mg (ICER, $141,957) and with an anticholinergic market basket (assessed by market share; ICER, $118,121). For Medicare, vibegron was cost effective at a WTP threshold of $50,000/QALY compared with mirabegron 50 mg (ICER, $12,154) and at a WTP threshold of $100,000/QALY compared with mirabegron 25 mg (ICER, $99,150) and with an anticholinergic market basket (ICER, $60,756). For commercial and Medicare payors, OWSAs for vibegron versus mirabegron 25 or 50 mg indicated cost effectiveness was most sensitive to vibegron persistence at 1 month and at 12 months. PSAs indicated that vibegron was cost effective compared with mirabegron 50 mg 98.6% and 100.0% of the time at $50,000/QALY for commercial payors and Medicare payors, respectively.

CONCLUSIONS: Vibegron is cost effective from a commercial payor (WTP threshold $150,000/QALY) and Medicare (WTP threshold $100,000/QALY) perspective when compared with other oral pharmacologic treatments for OAB.