Angulo Javier C, Valpas Antti, Rejas Javier, Linden Kari, Kvasz Marion, Snedecor Sonya J
Servicio de Urología, Hospital Universitario de Getafe, Crta Madrid-Toledo km 12,5, 28905, Getafe (Madrid), Spain,
Clin Drug Investig. 2014 May;34(5):297-307. doi: 10.1007/s40261-014-0178-1.
Overactive bladder is a prevalent condition worldwide that is associated with a considerable burden, both on the patient and on society.
Our objective was to assess the economic value of fesoterodine compared with tolterodine extended release (ER) for the treatment of overactive bladder (OAB) with urge urinary incontinence (UUI) in Spain and Finland.
A decision-tree economic model estimated the 52-week costs and quality-adjusted life-years (QALYs) of OAB/UUI patients initiating treatment with fesoterodine 4 mg/day or tolterodine ER. Individuals were evaluated for treatment response (UUI fewer than one episode/day) and persistence at weeks 4, 12, and 24. Titration from fesoterodine 4 mg/day to 8 mg/day was permitted at week 4. At week 12, non-responders discontinued treatment permanently. Efficacy, discontinuation, and utility data were derived from four clinical trials of fesoterodine. OAB-related costs, including physician visits, laboratory tests, incontinence pads, and comorbidities (fracture, skin infection, urinary tract infections, depression, and nursing home) were also included.
A total of 19.5 % and 18.0 % of fesoterodine and tolterodine ER patients remained on treatment until week 52, respectively. QALYs were higher with fesoterodine than tolterodine ER (0.762 vs. 0.760). In Spain, fesoterodine treatment had higher total costs than (generic) tolterodine ER (€6,697 vs. 6,597), resulting in a cost of €15,633/QALY gained. In Finland, fesoterodine was cost saving relative to (non-generic) tolterodine ER (€7,885 vs. 8,024). Sensitivity analysis confirmed that these findings were robust to the expected price decrease for generic tolterodine ER in Finland.
Fesoterodine is cost effective or cost saving relative to tolterodine ER for the treatment of OAB with UUI in two European countries. Payers and prescribers should consider a broad scope of costs to make informed cost-conscious choices of antimuscarinic treatment.
膀胱过度活动症在全球范围内普遍存在，给患者和社会都带来了相当大的负担。
我们的目的是评估在西班牙和芬兰，与托特罗定缓释剂型（ER）相比，非索罗定治疗伴有急迫性尿失禁（UUI）的膀胱过度活动症（OAB）的经济价值。
一个决策树经济模型估计了开始接受4毫克/天非索罗定或托特罗定ER治疗的OAB/UUI患者的52周成本和质量调整生命年（QALY）。在第4、12和24周对个体进行治疗反应（UUI少于每天一次发作）和持续性评估。允许在第4周将非索罗定从4毫克/天滴定至8毫克/天。在第12周，无反应者永久停止治疗。疗效、停药和效用数据来自四项非索罗定临床试验。还包括与OAB相关的成本，包括医生诊疗、实验室检查、失禁垫以及合并症（骨折、皮肤感染、尿路感染、抑郁症和疗养院）。
分别有19.5%和1
