Cost–effectiveness of overactive bladder treatments from a US commercial and payer perspective
Publication: Journal of Comparative Effectiveness Research
Abstract
Aim: The cost–effectiveness of treatment options (anticholinergics, β3-adrenoceptor agonists, onabotulinumtoxinA, sacral nerve stimulation and percutaneous tibial stimulation [the latter two including new rechargeable neurostimulators]) for the management of overactive bladder (OAB) were compared with best supportive care (BSC) using a previously published Markov model. Materials & methods: Cost–effectiveness was evaluated over a 15-year time horizon, and sensitivity analyses were performed using 2- and 5-year horizons. Discontinuation rates, resource utilization, and costs were derived from published sources. Results: Using Medicare and commercial costs over a 15-year time period, onabotulinumtoxinA 100U had incremental cost–effectiveness ratios (ICERs) gained of $39,591/quality-adjusted life-year (QALY) and $42,255/QALY, respectively, versus BSC, which were the lowest ICERs of all assessed treatments. The sensitivity analyses at 2- and 5-year horizons also showed onabotulinumtoxinA to be the most cost-effective of all assessed treatments versus BSC. Conclusion: OnabotulinumtoxinA 100U is currently the most cost-effective treatment for OAB.
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References
Papers of special note have been highlighted as: •• of considerable interest
1.
Abrams P, Cardozo L, Fall M et al. The standardisation of terminology of lower urinary tract function: report from the Standardisation Sub-committee of the International Continence Society. Neurourol. Urodyn 21(2), 167–178 (2002).
2.
Haylen BT, De Ridder D, Freeman RM et al. An International Urogynecological Association (IUGA)/International Continence Society (ICS) joint report on the terminology for female pelvic floor dysfunction. Neurourol. Urodyn. 29(1), 4–20 (2010).
•• Seminal paper defining overactive bladder.
3.
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).
•• Seminal paper on prevalence of overactive bladder.
4.
Coyne KS, Wein A, Nicholson S, Kvasz M, Chen CI, Milsom I. Economic burden of urgency urinary incontinence in the United States: a systematic review. J. Manag. Care Pharm. 20(2), 130–140 (2014).
5.
Gormley EA, Lightner DJ, Burgio KL et al. Diagnosis and treatment of overactive bladder (non-neurogenic) in adults: AUA/SUFU guideline. J. Urol. 188(Suppl. 6), 2455–2463 (2012).
•• Seminal paper describing the most relevant guidelines for overactive bladder (OAB) management in the USA.
6.
Lightner DJ, Gomelsky A, Souter L, Vasavada SP. Diagnosis and treatment of overactive bladder (non-neurogenic) in adults: AUA/SUFU guideline amendment 2019. J. Urol. 202(3), 558–563 (2019).
•• Most recent update of the guidelines for OAB management in the USA.
7.
Chen LC, Kuo HC. Pathophysiology of refractory overactive bladder. Low. Urin. Tract Symptoms 11(4), 177–181 (2019).
8.
Chancellor MB, Yehoshua A, Waweru C et al. Limitations of anticholinergic cycling in patients with overactive bladder (OAB) with urinary incontinence (UI): results from the CONsequences of Treatment Refractory Overactive bLadder (CONTROL) study. Int. Urol. Nephrol. 48(7), 1029–1036 (2016).
9.
Yehoshua A, Chancellor M, Vasavada S et al. Health resource utilization and cost for patients with incontinent overactive bladder treated with anticholinergics. J. Manag. Care Spec. Pharm. 22(4), 406–413 (2016).
10.
Yeowell G, Smith P, Nazir J, Hakimi Z, Siddiqui E, Fatoye F. Real-world persistence and adherence to oral antimuscarinics and mirabegron in patients with overactive bladder (OAB): a systematic literature review. BMJ Open 8(11), e021889 (2018).
11.
Murray B, Hessami SH, Gultyaev D et al. cost–effectiveness of overactive bladder treatments: from the US payer perspective. J. Comp. Eff. Res. 8(1), 61–71 (2019).
12.
Urovant Sciences Inc. Gemtesa (vibegron) prescribing information. (2020).
13.
Axonics. Axonics Sacral Neuromodulation System summary of safety and effectiveness data. (2019).
14.
Mccrery R, Lane F, Benson K et al. Treatment of urinary urgency incontinence using a rechargeable SNM system: 6-month results of the ARTISAN-SNM study. J. Urol. 203(1), 185–192 (2020).
15.
De Wachter S, Knowles CH, Elterman DS et al. New technologies and applications in sacral neuromodulation: an update. Adv. Ther. 37(2), 637–643 (2020).
16.
Medicare Payment Advisory Commission. March 2020 Report to the Congress: Medicare payment policy. (2020). www.medpac.gov/document/http-www-medpac-gov-docs-default-source-reports-mar20_entirereport_sec-pdf/
17.
York Health Economics Consortium. Allergan data on file. Network meta-analysis for BOTOX: mirabegron and anticholinergics. (2016).
18.
Drake MJ, Nitti VW, Ginsberg DA et al. Comparative assessment of the efficacy of onabotulinumtoxinA and oral therapies (anticholinergics and mirabegron) for overactive bladder: a systematic review and network meta-analysis. BJU Int 120(5), 611–622 (2017).
19.
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).
20.
Nitti VW, Dmochowski R, Herschorn S et al. OnabotulinumtoxinA for the treatment of patients with overactive bladder and urinary incontinence: results of a phase III, randomized, placebo controlled trial. J. Urol. 189(6), 2186–2193 (2013).
21.
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).
22.
Noblett K, Siegel S, Mangel J et al. Results of a prospective, multicenter study evaluating quality of life, safety, and efficacy of sacral neuromodulation at twelve months in subjects with symptoms of overactive bladder. Neurourol. Urodyn. 35(2), 246–251 (2016).
23.
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).
24.
Blok B, Van Kerrebroeck P, De Wachter S et al. Three month clinical results with a rechargeable sacral neuromodulation system for the treatment of overactive bladder. Neurourol. Urodyn. 37(S2), S9–S16 (2018).
25.
Blok B, Van Kerrebroeck P, De Wachter S et al. A prospective, multicenter study of a novel, miniaturized rechargeable sacral neuromodulation system: 12-month results from the RELAX-OAB study. Neurourol. Urodyn. 38(2), 689–695 (2019).
26.
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).
27.
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).
28.
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).
29.
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).
30.
Micron Medical. Micron Medical Corporate Presentation. (2020).
31.
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 [retracted article]. BJU Int. 116(6), 945–954 (2015).
32.
National Institute for Health and Clinical Excellence. Percutaneous posterior tibial nerve stimulation for overactive bladder syndrome: Interventional procedures guidance [IPG362]. (2010). https://www.nice.org.uk/guidance/IPG362 (September 19, 2022).
33.
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).
•• Primary source for derivation of quality-adjusted life-years in the model.
34.
Ibm Micromedex. RED BOOK Online. A comprehensive, consistent drug pricing resource. www.ibm.com/products/micromedex-red-book
35.
American Medical Association. Code Book. (2016). https://ocm.ama-assn.org/OCM/CPTRelativeValueSearch.do
36.
Allergan Plc. MarketScan. Data on file. (2016).
37.
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).
38.
Noridian Healthcare Solutions Durable Medical Equipment Coding System Fee Schedule Lookup Tool. https://med.noridianmedicare.com/web/jddme/fees-news/fee-schedules/lookup-tool
39.
Centers for Medicare and Medicaid Services. Medicare Physician fee schedule. www.cms.gov/Medicare/Medicare-Fee-for-Service-Payment/PhysicianFeeSched/
40.
Centers for Medicare and Medicaid Services. Ambulatory Surgical Center (ASC) payment rates. www.cms.gov/Medicare/Medicare-Fee-for-Service-Payment/ASCPayment/archive.html
41.
Blue Cross Blue Shield. Medical coverage policies: sacral nerve stimulation. (2008). www.bcbsri.com/sites/default/files/polices/SacralNerveStimulation.pdf
42.
Prieto L, Sacristán JA. Problems and solutions in calculating quality-adjusted life years (QALYs). Health Qual. Life Outcomes 1, 80 (2003).
43.
Vanness DJ, Lomas J, Ahn H. A health opportunity cost threshold for cost–effectiveness analysis in the United States. Ann. Intern. Med. 174(1), 25–32 (2021).
44.
Hamid R, Lorenzo-Gomez MF, Schulte-Baukloh H, Boroujerdi A, Patel A, Farrelly E. OnabotulinumtoxinA is a well tolerated and effective treatment for refractory overactive bladder in real-world practice. Int. Urogynecol. J. 32(1), 65–74 (2021).
45.
Mccammon K, Gousse A, Kohan A et al. Early and consistent improvements in urinary symptoms and quality of life with onabotulinumtoxinA in patients with overactive bladder and urinary incontinence: results from a randomized, placebo-controlled, phase IV clinical trial. Female Pelvic Med. Reconstr. Surg. 27(7), 450–456 (2021).
46.
Gousse AE, Kanagarajah P, Ayyathurai R, Handa P, Dabas N, Gomez CS. Repeat intradetrusor injections of onabotulinum toxin A for refractory idiopathic overactive bladder patients: a single-center experience. Female Pelvic Med. Reconstr. Surg. 17(5), 253–257 (2011).
47.
Harvie HS, Amundsen CL, Neuwahl SJ et al. Cost–effectiveness of sacral neuromodulation versus onabotulinumtoxinA for refractory urgency urinary incontinence: results of the ROSETTA randomized trial. J. Urol. 203(5), 969–977 (2020).
48.
Leong RK, De Wachter SG, Joore MA, Van Kerrebroeck PEV. Cost–effectiveness analysis of sacral neuromodulation and botulinum toxin A treatment for patients with idiopathic overactive bladder. BJU Int. 108(4), 558–564 (2011).
49.
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).
50.
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).
51.
Hassouna MM, Sadri H. Economic evaluation of sacral neuromodulation in overactive bladder: a Canadian perspective. Can. Urol. Assoc. J. 9(7–8), 242–247 (2015).
52.
Retraction: The cost–effectiveness of sacral nerve stimulation (SNS) for the treatment of idiopathic medically refractory overactive bladder (wet) in the UK. BJU Int. 122(2), E3 (2018).
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Received: 17 May 2022
Accepted: 10 November 2022
Published online: 19 January 2023
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Cost–effectiveness of overactive bladder treatments from a US commercial and payer perspective. (2023) Journal of Comparative Effectiveness Research. DOI: 10.2217/cer-2022-0089
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