Cost-Effectiveness of Mirabegron Compared with Antimuscarinic Agents for the Treatment of Adults with Overactive Bladder in the United Kingdom

Value Health. 2015 Sep;18(6):783-90. doi: 10.1016/j.jval.2015.05.011. Epub 2015 Sep 9.

Abstract

Background: Mirabegron, a first-in-class selective oral β3-adrenoceptor agonist, has similar efficacy to most antimuscarinic agents and a lower incidence of dry mouth in patients with overactive bladder (OAB).

Objectives: To evaluate the cost-effectiveness of mirabegron 50 mg compared with oral antimuscarinic agents in adults with OAB from a UK National Health Service perspective.

Methods: A Markov model including health states for symptom severity, treatment status, and adverse events was developed. Cycle length was 1 month, and the time horizon was 5 years. Antimuscarinic comparators were tolterodine extended release, solifenacin, fesoterodine, oxybutynin extended release and immediate release (IR), darifenacin, and trospium chloride modified release. Transition probabilities for symptom severity levels and adverse events were estimated from a mirabegron trial and a mixed treatment comparison. Estimates for other inputs were obtained from published literature or expert opinion. Quality-adjusted life-years (QALYs) and total health care costs, including costs of drug acquisition, physician visits, incontinence pad use, and botox injections, were modeled. Deterministic and probabilistic sensitivity analyses were performed.

Results: Base-case incremental cost-effectiveness ratios ranged from £367 (vs. solifenacin 10 mg) to £15,593 (vs. oxybutynin IR 10 mg) per QALY gained. Probabilistic sensitivity analyses showed that at a willingness-to-pay threshold of £20,000/QALY gained, the probability of mirabegron 50 mg being cost-effective ranged from 70.2% versus oxybutynin IR 10 mg to 97.8% versus darifenacin 15 mg. A limitation of our analysis is the uncertainty due to the lack of direct comparisons of mirabegron with other agents; a mixed treatment comparison using rigorous methodology provided the data for the analysis, but the studies involved showed heterogeneity.

Conclusions: Mirabegron 50 mg appears to be cost-effective compared with standard oral antimuscarinic agents for the treatment of adults with OAB from a UK National Health Service perspective.

Keywords: antimuscarinic drugs; cost-effectiveness analysis; mirabegron; overactive bladder.

Publication types

  • Comparative Study
  • Research Support, Non-U.S. Gov't

MeSH terms

  • Acetanilides / adverse effects
  • Acetanilides / economics*
  • Acetanilides / therapeutic use*
  • Adrenergic beta-3 Receptor Agonists / adverse effects
  • Adrenergic beta-3 Receptor Agonists / economics*
  • Adrenergic beta-3 Receptor Agonists / therapeutic use*
  • Adult
  • Bayes Theorem
  • Comparative Effectiveness Research
  • Computer Simulation
  • Cost-Benefit Analysis
  • Decision Support Techniques
  • Drug Costs*
  • Health Resources / economics*
  • Health Resources / statistics & numerical data
  • Humans
  • Markov Chains
  • Models, Economic
  • Muscarinic Antagonists / adverse effects
  • Muscarinic Antagonists / economics*
  • Muscarinic Antagonists / therapeutic use*
  • Patient Selection
  • Quality of Life
  • Quality-Adjusted Life Years
  • Severity of Illness Index
  • State Medicine / economics
  • Thiazoles / adverse effects
  • Thiazoles / economics*
  • Thiazoles / therapeutic use*
  • Time Factors
  • Treatment Outcome
  • United Kingdom
  • Urinary Bladder / drug effects
  • Urinary Bladder / physiopathology
  • Urinary Bladder, Overactive / diagnosis
  • Urinary Bladder, Overactive / drug therapy*
  • Urinary Bladder, Overactive / economics*
  • Urinary Bladder, Overactive / physiopathology

Substances

  • Acetanilides
  • Adrenergic beta-3 Receptor Agonists
  • Muscarinic Antagonists
  • Thiazoles
  • mirabegron