OBJECTIVES: To evaluate the cost-effectiveness of mirabegron versus two antimuscarinics, oxybutynin and tolterodine immediate release (IR), in patients with overactive bladder (OAB) from the perspective of the public healthcare system of Mexico.

METHODS: A Markov model simulated, over a 5-year time horizon, the therapeutic management, course of disease, and complications in hypothetical cohorts of patients with OAB and predicted costs and two outcomes: micturition state improvement (MSI), and incontinence state improvement (ISI). In each one-month cycle, patients could transition between different health states reflecting symptom severity. Transition probabilities were estimated from a mirabegron trial and mixed treatment comparison. The model accounted for treatment discontinuation based on treatment-specific rates of persistence found in published literature. Other inputs such as resource use and costs, including costs of anticholinergic burden, comorbidity treatment, drug acquisition, and physician visits, were obtained from published literature, expert opinion, and Portal de Compras IMSS. Deterministic and probabilistic sensitivity analyses were performed.

RESULTS: Mirabegron was costlier than its comparators, oxybutynin and tolterodine IR but conferred better improvement in terms of micturition and incontinence. Mirabegron was cost-effective at a willingness-to-pay (WTP) threshold of 167,000 Mexican pesos (MXN) per outcome of improvement. Mirabegron had an incremental cost effectiveness ratio (ICER) of 46,229 MXN/ISI and 51,243 MXN/ISI versus oxybutynin and tolterodine IR, respectively. Mirabegron had an ICER of 40,733 MXN/MSI and 44,350 MXN/MSI versus oxybutynin and tolterodine IR, respectively. Probabilistic sensitivity analyses showed that mirabegron was cost effective in 100% of simulations with a WTP of 167,000 for both measures of effects (i.e., MSI and ISI).

CONCLUSIONS: Relative to current standards of care with antimuscarinics, mirabegron is a cost-effective option for the treatment of OAB in the public healthcare system of Mexico.