Cost–effectiveness of overactive bladder treatments: from the US payer perspective
Abstract
Aim: To assess the cost–effectiveness of onabotulinumtoxinA (onabotA), implantable sacral nerve stimulation devices, percutaneous tibial nerve stimulation, anticholinergic medications and mirabegron compared with best supportive care (BSC) for management of refractory overactive bladder (OAB). Methods: A Markov model was developed to compare the cost–effectiveness of treatment options with BSC over a 10-year time horizon. Resource utilization, discontinuation rates and costs were derived from unpublished and published sources. Quality-adjusted life-years (QALYs) and incremental cost–effectiveness ratios were reported. Results: Treatment with onabotA 100U produced the largest gain in QALYs (7.179) and lowest estimated incremental cost–effectiveness ratio ($32,680/QALY) of all assessed treatments compared with BSC. Conclusion: Compared with BSC, onabotA 100U was the most cost-effective treatment option for patients with refractory OAB.
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References
Papers of special note have been highlighted as: • of interest; •• of considerable interest
1.
Stewart WF, Van Rooyen JB, Cundiff GW et al. Prevalence and burden of overactive bladder in the United States. World J. Urol. 20(6), 327–336 (2003).
•• This is a seminal paper describing the prevalence and burden of overactive bladder (OAB).
2.
Milsom I, Coyne KS, Nicholson S, Kvasz M, Chen CI, Wein AJ. Global prevalence and economic burden of urgency urinary incontinence: a systematic review. Eur. Urol. 65(1), 79–95 (2014).
•• This is a seminal paper describing the prevalence and burden of OAB.
3.
Gormley EA, Lightner DJ, Burgio KL et al. Diagnosis and treatment of overactive bladder (non-neurogenic) in adults: AUA/SUFU guideline. J. Urol. 188(6 Suppl.), 2455–2463 (2012).
•• This is a seminal paper describing the most relevant guidelines for OAB management in the USA.
4.
Gormley EA, Lightner DJ, Faraday M, Vasavada SP. American Urological Association, Society of Urodynamics; Female Pelvic Medicine. Diagnosis and treatment of overactive bladder (non-neurogenic) in adults: AUA/SUFU guideline amendment. J. Urol. 193(5), 1572–1580 (2015).
•• This is an update of the guidelines for OAB management in the USA.
5.
Weiss JP. Nocturia: focus on etiology and consequences. Rev. Urol. 14(3–4), 48–55 (2012).
6.
Wielage RC, Perk S, Campbell NL et al. Mirabegron for the treatment of overactive bladder: cost–effectiveness from US commercial health-plan and medicare advantage perspectives. J. Med. Econ. 19(12), 1135–1143 (2016).
7.
Mansley EC, Carroll NV, Chen KS et al. Good research practices for measuring drug costs in cost–effectiveness analyses: a managed care perspective: the ISPOR Drug Cost Task Force report--Part III. Value Health 13(1), 14–17 (2010).
8.
Micromedex RED BOOK Online® 2.0. A comprehensive, consistent drug pricing resource. http://truvenhealth.com/Products/Micromedex/Product-Suites/Clinical-Knowledge/RED-BOOK.
9.
Kay S, Tolley K, Colayco D, Khalaf K, Anderson P, Globe D. Mapping EQ-5D utility scores from the incontinence quality of life questionnaire among patients with neurogenic and idiopathic overactive bladder. Value Health 16(2), 394–402 (2013).
• This is the primary source for derivation of quality-adjusted life-years in the model.
10.
Noblett KL, Cadish LA. Sacral nerve stimulation for the treatment of refractory voiding and bowel dysfunction. Am. J. Obstet. Gynecol. 210(2), 99–106 (2014).
11.
Peters KM, Carrico DJ, Perez-Marrero RA et al. Randomized trial of percutaneous tibial nerve stimulation versus Sham efficacy in the treatment of overactive bladder syndrome: results from the SUmiT trial. J. Urol. 183(4), 1438–1443 (2010).
12.
Peters KM, Carrico DJ, Wooldridge LS, Miller CJ, Macdiarmid SA. Percutaneous tibial nerve stimulation for the long-term treatment of overactive bladder: 3-year results of the STEP study. J. Urol. 189(6), 2194–2201 (2013).
13.
Peters KM, Carrico DJ, Macdiarmid SA et al. Sustained therapeutic effects of percutaneous tibial nerve stimulation: 24-month results of the STEP study. Neurourol. Urodyn. 32(1), 24–29 (2013).
14.
Cameron AP, Anger JT, Madison R, Saigal CS, Clemens JQ. Urologic Diseases in America Project. National trends in the usage and success of sacral nerve test stimulation. J. Urol. 185(3), 970–975 (2011).
15.
York Health Economics Consortium. Allergan data on file. Network meta-analysis for BOTOX: mirabegron and anticholinergics (2016).
16.
Centers for Medicare and Medicaid Services Medicare Physician Fee Schedule. www.cms.gov/Medicare/Medicare-Fee-for-Service-Payment/PhysicianFeeSched/.
17.
Centers for Medicare and Medicaid Services Ambulatory Surgical Center (ASC) Payment Rates. www.cms.gov/Medicare/Medicare-Fee-for-Service-Payment/ASCPayment/archive.html.
18.
Noridian Healthcare Solutions Durable Medical Equipment Coding System Fee Schedule Lookup Tool. https://med.noridianmedicare.com/web/jddme/fees-news/fee-schedules/lookup-tool.
19.
American Medical Association. Code Book (2016). https://ocm.ama-assn.org/OCM/CPTRelativeValueSearch.do.
20.
Chapple C, Sievert KD, Macdiarmid S et al. OnabotulinumtoxinA 100 U significantly improves all idiopathic overactive bladder symptoms and quality of life in patients with overactive bladder and urinary incontinence: a randomised, double-blind, placebo-controlled trial. Eur. Urol. 64(2), 249–256 (2013).
21.
Nitti VW, Dmochowski R, Herschorn S et al. OnabotulinumtoxinA for the treatment of patients with overactive bladder and urinary incontinence: results of a phase 3, randomized, placebo controlled trial. J. Urol. 189(6), 2186–2193 (2013).
22.
Nitti VW, Ginsberg D, Sievert KD et al. Durable efficacy and safety of long-term onabotulinumtoxinA treatment in patients with overactive bladder syndrome: final results of a 3.5-year study. J. Urol. 196(3), 791–800 (2016).
23.
Allergan plc. MarketScan. Data on file (2016).
24.
Noblett K, Benson K, Kreder K. Detailed analysis of adverse events and surgical interventions in a large prospective trial of sacral neuromodulation therapy for overactive bladder patients. Neurourol. Urodyn. 36(4), 1136–1139 (2017).
25.
Chen HW, Bercik RS, Werner EF, Thung SF. Cost–effectiveness of percutaneous tibial nerve stimulation versus extended release tolterodine for overactive bladder. J. Urol. 187(1), 178–184 (2012).
26.
Briggs AH, Ades AE, Price MJ. Probabilistic sensitivity analysis for decision trees with multiple branches: use of the Dirichlet distribution in a Bayesian framework. Med. Decis. Making 23(4), 341–350 (2003).
27.
Sonnenberg FA, Beck JR. Markov models in medical decision making: a practical guide. Med. Decis. Making 13(4), 322–338 (1993).
28.
Leong RK, De Wachter SG, Joore MA, Van Kerrebroeck PE. Cost–effectiveness analysis of sacral neuromodulation and botulinum toxin A treatment for patients with idiopathic overactive bladder. BJU Int. 108(4), 558–564 (2011).
29.
Arlandis S, Castro D, Errando C et al. Cost–effectiveness of sacral neuromodulation compared to botulinum neurotoxin a or continued medical management in refractory overactive bladder. Value Health 14(2), 219–228 (2011).
30.
Autiero SW, Hallas N, Betts CD, Ockrim JL. The cost–effectiveness of sacral nerve stimulation (SNS) for the treatment of idiopathic medically refractory overactive bladder (wet) in the UK. BJU Int. 116(6), 945–954 (2015).
31.
Bertapelle MP, Vottero M, Popolo GD et al. Sacral neuromodulation and Botulinum toxin A for refractory idiopathic overactive bladder: a cost–utility analysis in the perspective of Italian healthcare system. World J. Urol. 33(8), 1109–1117 (2015).
32.
Hassouna MM, Sadri H. Economic evaluation of sacral neuromodulation in overactive bladder: a Canadian perspective. Can. Urol. Assoc. 9(7–8), 242–247 (2015).
33.
Visco AG, Zyczynski H, Brubaker L et al. Cost–effectiveness analysis of anticholinergics versus botox for urgency urinary incontinence: results from the anticholinergic versus botox comparison randomized trial. Female Pelvic Med. Reconstr. Surg. 22(5), 311–316 (2016).
34.
Siegel S, Noblett K, Mangel J et al. Three-year follow-up results of a prospective, multicenter study in overactive bladder subjects treated with sacral neuromodulation. Urology 94, 57–63 (2016).
35.
Amundsen CL, Richter HE, Menefee SA et al. OnabotulinumtoxinA vs sacral neuromodulation on refractory urgency urinary incontinence in women: a randomized clinical trial. JAMA 316(13), 1366–1374 (2016).
36.
Amundsen CL, Richter HE, Menefee S et al. The refractory overactive bladder: Sacral NEuromodulation vs. BoTulinum Toxin Assessment: ROSETTA trial. Contemp. Clin. Trials 37(2), 272–283 (2014).
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© 2018 Brian Murray et al.
History
Received: 23 July 2018
Accepted: 29 October 2018
Published online: 4 December 2018
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Cost–effectiveness of overactive bladder treatments: from the US payer perspective. (2018) Journal of Comparative Effectiveness Research. DOI: 10.2217/cer-2018-0079
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- Gabriela Gonzalez, Jennifer T. Anger, The Epidemiology and Socioeconomic Impact of Female GU and Pelvic Floor Disorders, Female Genitourinary and Pelvic Floor Reconstruction, 10.1007/978-3-031-19598-3_5, (85-95), (2023).
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- Victor Nitti, Cornelia Haag-Molkenteller, Michael Kennelly, Michael Chancellor, Brenda Jenkins, Brigitte Schurch, Treatment of neurogenic detrusor overactivity and overactive bladder with Botox (onabotulinumtoxinA): Development, insights, and impact, Medicine, 10.1097/MD.0000000000032377, 102, S1, (e32377), (2023).
- Nawal Khan, Muhammad Shamim Khan, Sachin Malde, Arun Sahai, Prokar Dasgupta, The translational implications of the science behind the overactive bladder and the role of OnabotulinumtoxinA, The Surgeon, 10.1016/j.surge.2022.09.004, 21, 3, (e126-e132), (2023).