COST EFFECTIVENESS OF SOLIFENACIN COMPARED WITH ORAL ANTIMUSCARINIC AGENTS FOR THE TREATMENT OF PATIENTS WITH OVERACTIVE BLADDER (OAB) IN THE UK
Author(s)
Kelleher C1, Aballea S2, Maman K3, Nazir J4, Hakimi Z5, Chambers C4, Odeyemi IA4
1Guy's and St. Thomas' NHS Foundation Trust, London, UK, 2Creativ-Ceutical, Paris, France, 3Creativ Ceutical, Paris, France, 4Astellas Pharma Europe Ltd, Chertsey, UK, 5Astellas Pharma Global Development, Leiden, The Netherlands
OBJECTIVES To evaluate the cost effectiveness of solifenacin 5mg compared with other oral antimuscarinic agents in adults with OAB from a UK NHS payer perspective METHODS A Markov model was developed to model major symptoms of OAB and the efficacy and tolerability of antimuscarinics. A 5-year time-horizon with monthly cycles was used in the base case. Five levels of symptom severity were used for micturitions and incontinence (total: 25 health states). Treatment with at least two antimuscarinic agents was assumed before patients received botulinum toxin. For each antimuscarinic, there was a probability of continuing or discontinuing medication, or switching to an alternative antimuscarinic with or without adverse events. Efficacy and tolerability inputs were based on a phase 3 study of solifenacin (Chapple et al. BJU Int 2004;93:303–10) and a mixed treatment comparison (results reported separately). Other model inputs were determined from the literature or expert opinion. All costs were based on GBP 2012/2013. Utilities were based on EuroQol-5Dncremental cost-effectiveness ratios (ICER) were expressed as cost/quality-adjusted life year (QALY). Deterministic (DSA) and probabilistic (PSA) sensitivity analyses were performed. RESULTS Solifenacin 5mg was dominant versus tolterodine extended-release 4mg, darifenacin 7.5mg, fesoterodine 4mg and solifenacin 10mg, and cost-effective versus darifenacin 15mg (ICER=£982.89/QALY), fesoterodine 8mg (ICER=£232.53/QALY), oxybutynin extended-release 10mg (ICER=£1117.32/QALY) and trospium 60mg (ICER=£3674.25/QALY). Both DSA and PSA showed that results were robust at a willingness-to-pay threshold of £t a cost-effectiveness threshold of £20,000/QALY, the probabilities that solifenacin 5mg was cost-effective versus comparators were: 95.4% (tolterodine extended-release 4mg), 92.1% (solifenacin 10mg), 97.3% (fesoterodine 4mg), 99.6% (fesoterodine 8mg), 99.4% (oxybutynin extended-release 10mg), 99.4% (darifenacin 7.5mg), 99.2% (darifenacin 15mg), and 97.3% (trospium 60mg). CONCLUSIONS Solifenacin 5mg appears to be a cost-effective strategy compared with other oral antimuscarinic agents for the treatment of adults with OAB from a UK NHS perspective.
Conference/Value in Health Info
2014-11, ISPOR Europe 2014, Amsterdam, The Netherlands
Value in Health, Vol. 17, No. 7 (November 2014)
Code
PUK16
Topic
Economic Evaluation
Topic Subcategory
Cost-comparison, Effectiveness, Utility, Benefit Analysis
Disease
Urinary/Kidney Disorders