Cost-effectiveness of vibegron for the treatment of overactive bladder in the United States

Abstract

Aims

To evaluate the cost-effectiveness of vibegron compared with other oral pharmacologic therapies as treatment for overactive bladder (OAB).

Methods

A semi-Markov model with monthly cycles was developed to support a lifetime horizon of vibegron 75 mg from a US commercial payor or Medicare perspective. The model incorporated efficacy (reductions in daily micturitions and urinary incontinence episodes), adverse events, OAB-related comorbidities, drug–drug interactions, anticholinergic burden, and treatment persistence. Direct costs and quality-adjusted life years (QALY) were accumulated over time. The primary outcome was the cost per QALY incremental cost-effectiveness ratio (ICER). One-way (OWSA) and probabilistic sensitivity analyses (PSA) were performed.

Results

For commercial payors, vibegron was cost-effective at a willingness-to-pay (WTP) threshold of $50,000/QALY versus mirabegron 50 mg (ICER, $9,311) and at a WTP threshold of $150,000/QALY versus mirabegron 25 mg (ICER, $141,957) and versus an anticholinergic basket based on market share (ICER, $118,121). For Medicare, vibegron was cost-effective at a WTP threshold of $50,000/QALY versus mirabegron 50 mg (ICER, $12,154) and at a WTP threshold of $100,000/QALY versus mirabegron 25 mg (ICER, $99,150) and versus an anticholinergic market basket (ICER, $60,756). For commercial payors and Medicare, OWSAs for vibegron versus mirabegron indicated cost-effectiveness was most sensitive to vibegron persistence at 1 and 12 months. PSAs indicated that vibegron was cost-effective versus mirabegron 50 mg 98.6% and 100% of the time at $50,000/QALY for commercial payors and Medicare payors, respectively.

Limitations

Due to lack of real-world data available on persistence, vibegron was assumed to have the same persistence as mirabegron 50 mg. Long-term efficacy was assumed to be sustained beyond 52 weeks in the absence of clinical trials longer than 52 weeks.

Conclusions

Vibegron is cost-effective from a commercial payor (WTP threshold $150,000/QALY) and Medicare (WTP threshold $100,000/QALY) perspective when compared with other oral pharmacologic treatments for OAB.

PLAIN LANGUAGE SUMMARY

Overactive bladder (OAB) affects more than 30 million adults in the United States. OAB is a condition associated with frequent and sudden urges to urinate. Drugs for treating OAB may improve symptoms for patients. Anticholinergic drugs are one type of drug available for treating OAB. Anticholinergic drugs may cause side effects such as dry mouth and constipation. Newer types of drugs called β₃-adrenergic receptor agonists are available for treating OAB symptoms. Vibegron is a member of the β₃-adrenergic receptor agonist class of drugs. Vibegron does not cause the same side effects related to anticholinergic drugs such as dry mouth and constipation. β₃-adrenergic receptor agonists work well for OAB symptoms but may be more expensive than anticholinergic drugs. It is important to choose drugs that work well and that are a reasonable price. This study assessed if vibegron is cost-effective for people enrolled in US private insurance and Medicare plans. Compared with other common drugs such as anticholinergic drugs for OAB, vibegron is cost-effective for people enrolled in private insurance and Medicare plans. This was in part because vibegron works better for longer and causes fewer adverse effects than other drugs. Vibegron may be considered “good value for money” for patients with OAB.

Keywords:

• Overactive bladder
• urology
• incontinence
• cost-effectiveness analysis
• vibegron
• semi-Markov model

JEL CODES:

• C52
• C5
• C
• I11
• I1
• I

Transparency

 

Declaration of funding

Funding for this study and for medical writing and editorial support was provided by Urovant Sciences (Irvine, CA).

Declaration of financial/other interests

JVC was an employee of Medical Decision Modeling Inc., a contract research company that performed the outcomes research described, at the time the work was conducted. TMK is an employee of Medical Decision Modeling. JN is an employee of Urovant Sciences. PNM was an employee of Urovant Sciences at the time the work was conducted.

Author contributions

All authors contributed to the study design, data analysis, and interpretation; revision of the manuscript for critically important content; and are responsible for the final approval of the manuscript for submission.

Acknowledgements

Medical writing and editorial assistance was provided by Rick Davis, MS, RPh, for and Krystina Neuman, PhD, CMPP, of The Curry Rockefeller Group, LLC (Tarrytown, NY), and was funded by Urovant Sciences.

Reviewer disclosures

A reviewer on this manuscript has disclosed that they have received a speaker fee from Urovant Sciences. The other peer reviewers on this manuscript have no other relevant financial relationships or otherwise to disclose.

Previous presentations

Presented in part at the Virtual International Society for Pharmacoeconomics and Outcomes Research meeting (ISPOR 2021), 17–21 May 2021.