Nazir J, Hart W M
Astellas Pharma Europe Ltd , Chertsey, Surrey , UK.
J Med Econ. 2014 Jun;17(6):408-14. doi: 10.3111/13696998.2014.910217. Epub 2014 Apr 16.
To carry out a cost-utility analysis comparing initial treatment of patients with overactive bladder (OAB) with solifenacin 5 mg/day versus either trospium 20 mg twice a day or trospium 60 mg/day from the perspective of the German National Health Service.
A decision analytic model with a 3 month cycle was developed to follow a cohort of OAB patients treated with either solifenacin or trospium during a 1 year period. Costs and utilities were accumulated as patients transitioned through the four cycles in the model. Some of the solifenacin patients were titrated from 5 mg to 10 mg/day at 3 months. Utility values were obtained from the published literature and pad use was based on a US resource utilization study. Adherence rates for individual treatments were derived from a United Kingdom general practitioner database review. The change in the mean number of urgency urinary incontinence episodes/day from after 12 weeks was the main outcome measure. Baseline effectiveness values for solifenacin and trospium were calculated using the Poisson distribution. Patients who failed second-line therapy were referred to a specialist visit. Results were expressed in terms of incremental cost-utility ratios.
Total annual costs for solifenacin, trospium 20 mg and trospium 60 mg were €970.01, €860.05 and €875.05 respectively. Drug use represented 43%, 28% and 29% of total costs and pad use varied between 45% and 57%. Differences between cumulative utilities were small but favored solifenacin (0.6857 vs. 0.6802 to 0.6800). The baseline incremental cost-effectiveness ratio ranged from €16,657 to €19,893 per QALY.
The difference in cumulative utility favoring solifenacin was small (0.0055-0.0057 QALYs). A small absolute change in the cumulative utilities can have a marked impact on the overall incremental cost-effectiveness ratios (ICERs) and care should be taken when interpreting the results.
Solifenacin would appear to be cost-effective with an ICER of no more than €20,000/QALY. However, small differences in utility between the alternatives means that the results are sensitive to adjustments in the values of the assigned utilities, effectiveness and discontinuation rates.
从德国国家医疗服务体系的角度，对膀胱过度活动症（OAB）患者初始使用索利那新5毫克/天与每日两次服用曲司氯铵20毫克或曲司氯铵60毫克/天进行成本效用分析。
建立一个为期3个月周期的决策分析模型，以跟踪一组在1年期间接受索利那新或曲司氯铵治疗的OAB患者。随着患者在模型中的四个周期过渡，成本和效用得以累积。部分索利那新患者在3个月时从5毫克滴定至10毫克/天。效用值来自已发表的文献，护垫使用情况基于一项美国资源利用研究。个体治疗的依从率来自对英国全科医生数据库的回顾。主要结局指标为12周后每日急迫性尿失禁发作次数的平均变化。使用泊松分布计算索利那新和曲司氯铵的基线有效性值。二线治疗失败的患者转诊至专科就诊。结果以增量成本效用比表示。
索利那新、曲司氯铵20毫克和曲司氯铵60毫克的年度总成本分别为970.01欧元、860.05欧元和875.05欧元。药物使用占总成本的43%、28%和29%，护垫使用占比在45%至57%之间变化。累积效用之间的差异较小，但索利那新更具优势（0.6857对0.6802至0.6800）。基线增量成本效益比为每质量调整生命年16,657欧元至19,893欧元。
累积效用方面有利于索利那新的差异较小（0.0055 - 0.0057质量调整生命年）。累积效用的微小绝对变化可能对总体增量成本效益比（ICER）产生显著影响，解释结果时应谨慎。
索利那新似乎具有成本效益，ICER不超过20,000欧元/质量调整生命年。然而，各替代方案在效用上的微小差异意味着结果对指定效用值、有效性和停药率的调整较为敏感。
