A review of cost–effectiveness comparisons for overactive bladder treatments: which is the most cost-effective for improving quality of life?

Abstract

Overactive bladder (OAB) syndrome is a prevalent condition known to have a substantial impact on a patient’s quality of life (QoL). Treatment options are numerous and include pharmacotherapy and other non-invasive measures, as well as more or less invasive interventions. Antimuscarinics are the cornerstone of medical management. Given that millions of patients suffer OAB symptoms worldwide and there is abundance of treatment options available, selecting the treatment strategy that offers the best balance of QoL improvement to resources spent in achieving it becomes crucial in the current situation of healthcare budget restrictions worldwide. This review summarizes available evidence on economic analyses of OAB treatments aimed at identifying the most cost-effective in terms of improving QoL.

Keywords:

• antimuscarinics
• cost–effectiveness
• overactive bladder
• quality of life
• treatment
• urge incontinence

Financial & competing interests disclosure

A Athanasopoulos has acted as a consultant, lecturer or received research grants from Astellas, Pfizer, Lilly, Ranbaxy, Meditrina and Galenica. K Giannitsas has acted as a consultant, lecturer or received research grants from Astellas, Pfizer and Lilly. The authors have no other relevant affiliations or financial involvement with any organization or entity with a financial interest in or financial conflict with the subject matter or materials discussed in the manuscript apart from those disclosed.

Key issues

• Overactive bladder (OAB) is a prevalent condition with significant impact on patient’s quality of life.

• Antimuscarinics are the cornerstone of medical management of OAB.

• Economic evaluation of OAB treatments becomes increasingly interesting in the current environment of budget restrictions.

• The majority of published cost–effectiveness evaluations of OAB treatments concerns pharmacotherapy with antimuscarinics.

• Oxybutynin and tolterodine, the two most widely used drugs, have been evaluated in early studies and their extended-release formulations are cost-effective compared with immediate-release.

• Data on the comparison or extended formulation of tolterodine and oxybutynin are inconclusive.

• Solifenacin has been shown to be cost-effective to most of its comparators in recent trials, but data on cost–effectiveness to the other second-line antimuscarinic are scarce.

• As far as treatment for refractory OAB is concerned, although SNS is more effective, botulinum toxin-A seems to be the most cost-effective option. It seems impossible to decide which OAB treatment is the most cost-effective based on available information.