Sicras-Mainar Antoni, Navarro-Artieda Ruth, Ruiz-Torrejón Amador, Sáez-Zafra Marc, Coll-de Tuero Gabriel
Badalona Serveis Assistencials, Calle Gaietà Soler, 6-8 entlo, 08911, Badalona, Barcelona, Spain.
Medical Documentation, Hospital Germans Trias i Pujol, Badalona, Barcelona, Spain.
Clin Drug Investig. 2015 Dec;35(12):795-805. doi: 10.1007/s40261-015-0342-2.
Overactive bladder (OAB) is a syndrome characterized by presenting symptoms of urgency, with or without urge incontinence, and normally accompanied by day and night frequency.
The aim of this study was to evaluate the impact of lost work productivity [number of days of sick leave] in patients treated with fesoterodine versus tolterodine and solifenacin to treat OAB in Spain.
A retrospective, observational study was carried out using the records (digital databases) of actively working patients (2008-2013). The study population comprised of patients from two autonomous communities; 31 primary care centres agreed to participate. Patients who began first treatment with antimuscarinics (fesoterodine, solifenacin or tolterodine) and who met certain inclusion/exclusion criteria were included in the study. Follow-up lasted for 1 year. The main outcome measures were comorbidity, medication possession ratio (MPR), treatment persistence, and number of days of sick leave and associated costs. Indirect costs were considered to be those related to lost work productivity (number of days of sick leave, exclusively), (1) due to OAB and (2) overall total. The cost was expressed as the average cost per patient (cost/unit). Multivariate analyses (Cox, ANCOVA) were used to correct the models.
A total of 3094 patients were recruited into the study; 43.0 % were treated with solifenacin, 29.2 % with tolterodine, and 27.8 % with fesoterodine. The average age of patients was 54 years (standard deviation 9.2), and 62.2 % were women. The comparison of fesoterodine versus solifenacin and tolterodine showed a higher MPR (90.0 vs. 87.0 and 86.1 %, respectively), higher treatment persistence (40.2 vs. 34.7 and 33.6 %), lower use of sick leave (22.8 vs. 52.9 and 36.7 %), total number of days of sick leave (5.1 vs. 9.7 and 9.3 days) and costs corrected for covariates (€371 vs. €703 and €683); p < 0.05.
Despite the possible limitations of this study, active patients who began treatment with fesoterodine to treat OAB (compared with solifenacin or tolterodine) had fewer days of sick leave, resulting in lower costs due to lost productivity.
膀胱过度活动症（OAB）是一种以尿急症状为特征的综合征，伴有或不伴有急迫性尿失禁，通常还伴有日夜尿频。
本研究旨在评估在西班牙，使用非索罗定治疗膀胱过度活动症的患者与使用托特罗定和索利那新治疗的患者相比，病假天数所反映的工作效率损失情况。
采用回顾性观察研究，利用在职患者（2008 - 2013年）的记录（数字数据库）。研究人群包括来自两个自治区的患者；31个初级保健中心同意参与。开始使用抗毒蕈碱药物（非索罗定、索利那新或托特罗定）进行首次治疗且符合特定纳入/排除标准的患者被纳入研究。随访持续1年。主要观察指标包括合并症、药物持有率（MPR）、治疗持续性、病假天数及相关费用。间接成本被认为是与工作效率损失相关的成本（仅病假天数），（1）因膀胱过度活动症导致的，（2）总体总成本。成本以每位患者的平均成本（成本/单位）表示。采用多变量分析（Cox分析、协方差分析）对模型进行校正。
共3094例患者纳入研究；43.0%接受索利那新治疗，29.2%接受托特罗定治疗，27.8%接受非索罗定治疗。患者平均年龄为54岁（标准差9.2），62.2%为女性。非索罗定与索利那新和托特罗定的比较显示，非索罗定的药物持有率更高（分别为90.0%对87.0%和86.1%），治疗持续性更高（40.2%对34.7%和33.6%），病假使用率更低（22.8%对52.9%和36.7%），病假总天数更少（5.1天对9.7天和9.3天），经协变量校正后的成本更低（371欧元对703欧元和683欧元）；p < 0.05。
尽管本研究可能存在局限性，但与索利那新或托特罗定相比，开始使用非索罗定治疗膀胱过度活动症的在职患者病假天数更少，因生产力损失导致的成本更低。
