Compared with best supportive care (BSC), onabotulinumtoxinA was found to be the most cost-effective treatment for patients with refractory overactive bladder (OAB) from a US payer perspective, according to a comparative analysis published in Future Medicine.

Study authors developed a Markov model with health states based on daily urinary incontinence episodes to compare the cost-effectiveness of onabotulinumtoxinA, implantable sacral nerve stimulation devices, percutaneous tibial nerve stimulation, anticholinergic medications (eg, solifenacin, tolterodine extended-release), and mirabegron versus BSC (behavioral therapy, incontinence pads, and occasional catheterization) for the management of refractory OAB. A 10-year timeframe was established “to reflect the chronic nature of OAB and capture the key costs and effects related to all treatments assessed.” Factors such as resource utilization, discontinuation rates, and costs were obtained to calculate quality-adjusted life-years (QALYs) and incremental cost-effectiveness ratios. 

Results showed the largest gain in QALYs (7.179) and smallest estimated incremental cost-effectiveness ratio ($32,608/QALY) was associated with onabotulinumtoxinA when compared with BSC (7.069); QALYs gained ranged from 7.071 with tolterodine extended-release to 7.125 with sacral nerve stimulation. Compared with BSC, all of the other treatments resulted in an incremental cost-effectiveness ratio >$100,000. 

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The most expensive therapy was sacral nerve stimulation ($27,823 per patient over 10 years) and the least expensive therapy was BSC ($11,460 per patient). 

The authors concluded, “Of the available treatment options examined in this study, onabotulinumtoxinA was the most cost-effective for management of overactive bladder in patients who have inadequate response to or are intolerant of oral anticholinergic therapy.”

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