Hakimi Zalmai, Nazir Jameel, McCrea Charles, Berling Malin, Fatoye Francis, Ramos Barbara, Wagg Adrian
a Astellas Pharma Europe B.V. , Leiden , the Netherlands.
b Astellas Pharma Europe Ltd. , Chertsey , UK.
J Med Econ. 2017 Jun;20(6):614-622. doi: 10.1080/13696998.2017.1294595. Epub 2017 Mar 12.
The β-adrenoceptor agonist, mirabegron, and antimuscarinic agents provide similar efficacy for the treatment of overactive bladder (OAB), but mirabegron appears to be associated with better persistence, perhaps due to an absence of anticholinergic side-effects. This study estimated the expected costs associated with the management of OAB in Canada from a societal perspective by utilizing real-world evidence.
An economic model with monthly cycles and a 1-year time horizon was developed to depict a treatment pathway for a hypothetical cohort of 100 patients with OAB. At model entry, patients receive mirabegron or an antimuscarinic. Patients who do not persist may switch treatment, undergo a minimally invasive procedure, or remain symptomatic (uncontrolled). The model includes direct costs (e.g. physician visits) and indirect costs (e.g. lost productivity). A one-way univariate sensitivity analysis assessed a ±20% variation in each of the key model inputs.
At 1 year, a greater proportion of patients persisted on treatment with mirabegron compared with antimuscarinics (33% vs 15-23%), and a smaller proportion switched treatment (17% vs 20-22%). The number of healthcare visits (292 vs 299-304), pads used (74,098 vs 77,878-81,669), and work hours lost (4,497 vs 5,372-6,249) were all lower for mirabegron vs antimuscarinics. The estimated total annual cost of treatment per patient with mirabegron was $2,127.46 Canadian dollars (CAD) ($5.82 CAD/day) compared with $2,150.20-$2,496.69 CAD ($5.89-$6.84 CAD/day) for antimuscarinics. The one-way sensitivity analysis indicated the results are robust.
Improved persistence observed in routine clinical practice with mirabegron appears to translate into benefits of reduced healthcare resource use, and lower direct and indirect costs of treatment compared with antimuscarinics. Overall, these data suggest that mirabegron may offer clinical and economic benefits for the management of patients with OAB in Canada.
β-肾上腺素能受体激动剂米拉贝隆和抗毒蕈碱药物在治疗膀胱过度活动症（OAB）方面疗效相似，但米拉贝隆的持续用药率似乎更高，这可能是由于其没有抗胆碱能副作用。本研究利用真实世界证据，从社会角度估算了加拿大OAB管理的预期成本。
建立了一个每月循环、为期1年的经济模型，以描绘100名假设的OAB患者队列的治疗路径。在模型开始时，患者接受米拉贝隆或抗毒蕈碱药物治疗。未坚持治疗的患者可能会更换治疗方法、接受微创手术或症状持续（未得到控制）。该模型包括直接成本（如就诊费用）和间接成本（如生产力损失）。单向单因素敏感性分析评估了每个关键模型输入参数±20%的变化。
1年后，与抗毒蕈碱药物相比，使用米拉贝隆持续治疗的患者比例更高（33%对15%-23%），更换治疗的患者比例更低（17%对20%-22%）。米拉贝隆组的就诊次数（292次对299-304次）、使用的尿垫数量（74,098个对77,878-81,669个）和损失的工作时间（4,497小时对5,372-6,249小时）均低于抗毒蕈碱药物组。米拉贝隆治疗的每名患者估计每年总治疗成本为2,127.46加元（CAD）（5.82 CAD/天），而抗毒蕈碱药物的成本为2,150.20-2,496.69 CAD（5.89-6.84 CAD/天）。单向敏感性分析表明结果具有稳健性。
在常规临床实践中观察到米拉贝隆的持续用药率提高，这似乎转化为医疗资源使用减少的益处，与抗毒蕈碱药物相比，治疗的直接和间接成本更低。总体而言，这些数据表明米拉贝隆可能为加拿大OAB患者的管理带来临床和经济效益。
