Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada.
J Med Econ. 2010;13(3):508-15. doi: 10.3111/13696998.2010.509244.
To estimate the cost effectiveness of solifenacin 5 mg/day compared to oxybutynin immediate-release (IR) 15 mg/day in patients with overactive bladder, from the perspective of the Canadian healthcare (payer) system.
A Markov model was adapted to estimate the incremental cost per quality-adjusted life-year (QALY) of solifenacin and oxybutynin IR over a 1-year time horizon, based on efficacy and discontinuation data from the Canadian VECTOR (VEsicare in Comparison To Oxybutynin for oveRactive bladder patients) study. In the model, patients who discontinued treatment were offered tolterodine extended release 4 mg/day as second-line. Model robustness was tested using various sensitivity analyses. Utility values were derived from published literature; incontinence pads were included in a secondary analysis.
In the base-case analysis, total costs over 1 year were CAN$695 and CAN$550 in the solifenacin and oxybutynin IR groups, respectively. When including incontinence pad costs, there was an incremental saving of CAN$1,831 per patient with solifenacin. Solifenacin was associated with an incremental QALY gain of 0.01 over 1 year. In the base-case analysis without incontinence pads, the incremental cost-utility ratio for solifenacin was CAN$14,092. Probabilistic analyses showed no overlap in the 95% confidence intervals for total costs or QALYs with or without incontinence pads. Solifenacin was cost effective in >90% of cases, based on a willingness-to-pay threshold of CAN$50,000 per additional QALY, irrespective of whether pad costs were included in the model. The most influential variables were the discontinuation rates and the cost of incontinence pads. Limitations of the analysis relate mainly to the fact that data in the VECTOR study were collected using a direct questioning approach, which might have increased the reporting of dry mouth.
Solifenacin 5 mg/day was a cost-effective treatment compared with oxybutynin IR 15 mg/day.
NCT00431041 (of the VECTOR study, upon which the analysis in this paper was based).
从加拿大医疗保健（支付方）系统的角度出发，评估索利那新 5mg/天与奥昔布宁即时释放（IR）15mg/天治疗膀胱过度活动症（OAB）患者的成本效果。
基于加拿大 VECTOR（Vesicare 在治疗膀胱过度活动症患者中与 Oxybutynin 的比较）研究的疗效和停药数据，我们采用马尔可夫模型来估计索利那新和奥昔布宁 IR 治疗方案在 1 年时间范围内的每增加 1 个质量调整生命年（QALY）的增量成本。在模型中，停止治疗的患者可以选择二线药物托特罗定延长释放片 4mg/天。我们采用了各种敏感性分析来测试模型的稳健性。效用值来源于已发表的文献；在二次分析中纳入了失禁垫的费用。
在基线分析中，索利那新组和奥昔布宁 IR 组患者在 1 年内的总费用分别为 695 加元和 550 加元。如果纳入失禁垫费用，使用索利那新治疗可使每位患者节省 1831 加元。1 年内，索利那新组的 QALY 增加了 0.01。在不考虑失禁垫费用的基线分析中，索利那新的增量成本-效用比为 14092 加元。概率分析显示，是否纳入失禁垫，患者的总成本和 QALY 无重叠的 95%置信区间。在不计失禁垫费用的情况下，当以每增加 1 个 QALY 50000 加元为意愿支付阈值时，索利那新的治疗方案在 90%以上的情况下具有成本效果。最具影响力的变量是停药率和失禁垫的成本。分析的局限性主要与 VECTOR 研究的数据是通过直接询问的方式收集有关，这可能增加了口干的报告。
与奥昔布宁 IR 15mg/天相比，索利那新 5mg/天是一种具有成本效果的治疗方法。
NCT00431041（基于该分析的 VECTOR 研究）。
