PUK22 - Cost-Effectiveness of Mirabegron Compared with Antimuscarinics for the Treatment of Patients with Overactive Bladder in the United Kingdom

Abstract

Mirabegron is a first-in-class beta-3 adrenoceptor agonist for the treatment of overactive bladder (OAB) that demonstrated superior efficacy compared to placebo by reducing OAB symptoms and improving HRQoL. We sought to assess the cost-effectiveness of mirabegron 50 mg in comparison with current antimuscarinics for the treatment of patients with OAB in the UK. A Markov model was developed to simulate the therapeutic management, the changes in symptoms (micturitions and incontinence), and complications in hypothetical cohorts of OAB patients. The model was used to predict costs and QALYs over 5 years in cohorts initially treated with antimuscarinics or mirabegron 50mg. Effectiveness and safety data were based on the results from a mixed treatment comparison (MTC). A calibration approach was used to derive transition probabilities from mean changes in frequency of micturitions and incontinence episodes. Other input data were obtained from several sources, including scientific literature and expert opinions. Costs were evaluated from the UK National Health Service (NHS) perspective and included costs of drug acquisition, GP visits, specialist visit, incontinence pad use and botox injections. Utilities were obtained from equations predicting EQ-5D index scores according to symptom severity, estimated from a clinical trial of Mirabegron. The Mirabegron strategy was slightly more expensive and associated with a greater number of QALYs, as a result of improved persistence, related to a lower risk of adverse event compared to each antimuscarinic. Mirabegron 50mg was found to be cost-effective compared to each antimuscarinic, with an ICER of £340 vs. solifenacin 10mg, £3,607 versus fesoterodine 4mg, £3,715 vs. tolterodine ER 4mg, £3,878 vs. oxybutynin ER 10mg, £8,881 versus trospium chloride MR 60 mg, £12,493 versus solifenacin 5mg, and £14,234 oxybutynin IR 10mg. Treatment with mirabegron appears to be a cost-effective strategy compared with antimuscarinics from a UK NHS perspective.