Cost-effectiveness evaluation of mirabegron versus anti-muscarinics and third-line therapies: a systematic review

ABSTRACT

Background

Overactive bladder (OAB) is defined as urinary urgency, usually with urinary frequency and nocturia. . The current treatment for OAB includes conservative management, surgery, and pharmacotherapy. Mirabegron is a new drug acting by the ß3-adrenoceptor agonism. This study aimed to review the cost-effectiveness of mirabegron in the treatment of OAB.

Areas covered

We searched published articles in electronic search databases. Ten studies were included in the qualitative analysis. Various antimuscarinics, including oxybutynin, fesoterodine, tolterodine, darifenacin, and trospium were compared with mirabegron. The results were evaluated and compared according to the quality-adjusted life-years (QALY), cost/year, and incremental cost-effectiveness ratio (ICER). Of the ten studies in only three, mirabegron was not a cost-effective strategy. In seven cases, mirabegron was cost-effective.

Expert opinion

The cost-effectiveness of mirabegron was variable in different regions; however, most of the studies show the cost-effectiveness of mirabegron. Our study illustrates that mirabegron’s ICER in comparison with its comparators is below the willingness to pay threshold even in the countries with low GDP/Capita. Our proposal for future economic studies for OAB pharmacotherapy is to compare different doses, formulations, and administration forms in a real-world context.

KEYWORDS:

• Cost-effectiveness analysis
• systematic review
• economic evaluation
• overactive bladder
• mirabegron
• beta-3 adrenoceptor
• antimuscarinic agents

Article highlights

• Mirabegron, a selective oral β3-adrenoceptor agonist, in patients with overactive bladder (OAB) has similar efficacy to other antimuscarinics but, a lower incidence of xerostomia.

• Mirabegron provided higher utility in terms of QALYs due to lower side effects with similar efficacy to antimuscarinics.

• Although mirabegron is cost effective vs other antimuscarinics, compared to third-line interventions, such as posterior tibial nerve stimulation (PTNS) and OnabotulinumtoxinA injection, mirabegron is not cost-effective.

• Cost-effectiveness of mirabegron was variable in different regions of the world; however, most of the studies show the cost-effectiveness of mirabegron compared to antimuscarinics.

• Our study shows mirabegron’s incremental cost-effectiveness ratio in comparison with its comparators may be below the willingness to pay threshold even in the countries with low GDP/Capita, such as Colombia.

Acknowledgments

We want to thank the Student Research Committee of Shahid Beheshti University of Medical Sciences for its financial support and for providing the ethical code for this paper (IR.SBMU.RETECH.REC.1400.1129)

Declaration of interest

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.

Reviewer disclosures

One peer reviewer declares that they have previously participated in economic studies sponsored by Astellas Pharma. One peer reviewer declares that they have been a speaker and researcher for Astellas Pharma. Peer reviewers on this manuscript have no other relevant financial relationships or otherwise to disclose.

Additional information

Funding

This study was funded by students’ research committee, Shahid Beheshti University of medical sciences.