CATALYST Health Economics Consultants, Northwood, Middlesex, UK.
Clin Drug Investig. 2004;24(6):305-21. doi: 10.2165/00044011-200424060-00001.
To estimate the cost effectiveness of controlled-release (CR) oxybutynin compared with immediate-release (IR) oxybutynin and tolterodine in the treatment of overactive bladder (OAB) in Austria, France and the UK.
This was a modelling study on the management of patients with OAB who were >/=18 years of age, and had urge or mixed incontinence with a primary-urge component. The study was performed from the perspective of payers (i.e. the National Health Service [NHS] in the UK, Social Security in France and the Sick Funds in Austria) and patients.
Clinical outcomes attributable to managing OAB were obtained from the published literature, and resource utilisation estimates were derived from a panel of clinicians. Using decision analytical techniques, three decision models were constructed depicting the management of OAB with CR oxybutynin, IR oxybutynin and tolterodine over 6 months in the UK, France and Austria. The models were used to estimate the cost effectiveness of CR oxybutynin relative to the other two anticholinergic drugs in each of the three countries and the expected direct patient costs and indirect societal costs (at 2000/2001 prices).
Starting OAB treatment with CR oxybutynin instead of either IR oxybutynin or tolterodine in the UK and Austria was found to be a potentially dominant strategy, since it improves clinical outcome at a lower cost, from the payers' perspective. In France, starting OAB treatment with CR oxybutynin instead of either the IR formulation or tolterodine was found to be a potentially cost-effective strategy from the payer's perspective. The expected 6-monthly direct costs to patients were euro230, euro720-920 and euro970-1000 in the UK, France and Austria, respectively. In the UK and Austria, these costs were broadly consistent between initial treatments. However, in France, tolterodine-treated patients would be expected to incur 28% more expenditure than patients treated with the other two drugs. Transportation emerged as the primary cost driver, accounting for at least 60% of patients' out-of-pocket expenditure, in all three countries. Irrespective of the initial treatment, patients would be expected to miss 1-2 days of work over 6 months as a result of their OAB. This equates to an expected lost productivity cost of euro84, euro250 and euro98 in the UK, France and Austria, respectively.
Starting OAB treatment with CR oxybutynin is expected to be a clinically more effective strategy than starting with either IR oxybutynin or tolterodine, and potentially the most cost-effective strategy in all three countries.
评估控释（CR）奥昔布宁相对于即刻释放（IR）奥昔布宁和托特罗定在奥地利、法国和英国治疗膀胱过度活动症（OAB）的成本效益。
这是一项关于管理 >/=18 岁的 OAB 患者的建模研究，这些患者具有急迫性或混合性尿失禁，具有原发性急迫性成分。该研究从支付者（即英国国民保健制度[NHS]、法国社会保障和奥地利疾病基金）和患者的角度进行。
从已发表的文献中获得管理 OAB 的临床结果，从一组临床医生那里得出资源利用估计值。使用决策分析技术，在英国、法国和奥地利的 6 个月内，构建了三个描述用 CR 奥昔布宁、IR 奥昔布宁和托特罗定治疗 OAB 的决策模型。这些模型用于估计在这三个国家中，CR 奥昔布宁相对于其他两种抗胆碱能药物的成本效益，以及预期的直接患者成本和间接社会成本（以 2000/2001 年的价格计算）。
在英国和奥地利，从支付者的角度来看，开始 OAB 治疗时使用 CR 奥昔布宁而不是 IR 奥昔布宁或托特罗定被发现是一种潜在的主导策略，因为它以较低的成本改善了临床结果。在法国，从支付者的角度来看，开始 OAB 治疗时使用 CR 奥昔布宁而不是 IR 制剂或托特罗定被发现是一种潜在的具有成本效益的策略。预计英国、法国和奥地利的患者每 6 个月的直接成本分别为 230 欧元、720-920 欧元和 970-1000 欧元。在英国和奥地利，这些成本在初始治疗之间大致一致。然而，在法国，与其他两种药物相比，接受托特罗定治疗的患者预计会增加 28%的支出。交通在所有三个国家都是主要的成本驱动因素，占患者自费支出的至少 60%。无论初始治疗如何，预计患者在 6 个月内都会因 OAB 而错过 1-2 天的工作。这相当于英国、法国和奥地利的预期生产力损失成本分别为 84 欧元、250 欧元和 98 欧元。
与开始用 IR 奥昔布宁或托特罗定治疗相比，开始用 CR 奥昔布宁治疗 OAB 预计将是一种更有效的临床策略，并且在所有三个国家都可能是最具成本效益的策略。
