Abstract
To evaluate whether a difference in treatment dropout rate with mirabegron in overactive bladder (OAB) patients aged ≥ 65 years could generate cost savings to the National Health System (NHS) and gain quality-adjusted life years (QALYs), compared with the most commonly prescribed antimuscarinics (AM) in Spain (tolterodine, fesoterodine, oxybutynin, solifenacin). A probabilistic model (second order Monte Carlo simulation) in a hypothetical cohort of 1,000 patients aged ≥ 65 years with OAB and a time horizon of 1 year was carried out. Persistence rates, defining treatment discontinuation after a period of at least 30 days without prescription renewal, for both mirabegron and AM were obtained from a Spanish observational study in 1,149 patients ≥ 65 years-old. Unit costs (€ 2019) and utility loss associated to treatment discontinuation were obtained from Spanish public prices and literature, respectively. Persistence rates were higher in patients aged ≥ 65 years treated with mirabegron (20.2%) versus AM (10.2%), leading to a QALY gain of 0.0192 ± 0.0027 QALYs per year. Treatment with mirabegron could generate savings of 68.32 ± 12.19 € per patient per year compared to AM, with a 100% probability of saving (in all patients in the cohort). For the discontinuation criteria at 45, 60 and 90 days, the gain of QALYs with mirabegron versus AM would be 0.0227 ± 0.0058, 0.0225 ± 0.0072 and 0.0230 ± 0.0099, respectively. Saving per patient/year would be 80.75 ± 40.14 €, 78.74 ± 56.23 € and 78.19 ± 83.35 €, respectively. The result was stable for all univariate deterministic sensitivity analyzes. The probabilistic model presented showed a greater persistence in patients aged ≥ 65 years treated with mirabegron compared to AM, leading to a positive impact in OAB patients' quality of life, as well cost savings to the NHS in Spain.
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