Clinical and economic impact of mirabegron compared with antimuscarinics for the treatment of overactive bladder in Canada

Figures & data

Figure 1. Overview of the treatment pathway.

Figure 2. Overview of the Markov model.

Table 1. Clinical inputs included in the model.

Input variable	Default value	Source
Patients with incontinence	60.0%^a	Nitti et al.^26 (2013)
Patients switching treatment	26.06%	Aballéa et al.^23 (2015); Nazir et al.^24 (2015)
1-year persistence^b
Mirabegron 25/50 mg	31.7%	Wagg et al.^19 (2015)
Solifenacin 5/10 mg	22.0%	Wagg et al.^19 (2015)
Fesoterodine 4/8 mg	21.0%	Wagg et al.^19 (2015)
Oxybutynin ER 5 mg	18.9%	Wagg et al.^19 (2015)
Oxybutynin IR 10 mg	13.8%	Wagg et al.^19 (2015)
Tolterodine ER 4 mg	19.7%	Wagg et al.^19 (2015)
Tolterodine IR 2/4 mg	19.7%	Wagg et al.^19 (2015)
Probability of minimally invasive procedure	0.01%	Nazir et al.^24 (2015)
6-month probability of depression	18.8%	Arlandis-Guzman et al.^34 (2011)
6-month probability of UTI	30.7%	Arlandis-Guzman et al.^34 (2011)
General population mortality	0.49%	Statistics Canada^28 (2015)

ER: extended release; IR: intermediate release; UTI: urinary tract infection.

^a A conservative estimate of 60% was applied to the model, based on 65.7% of the total population who were reported to have urgency or mixed incontinence at baseline;

^b Wagg et al.¹⁹ does not differentiate between branded and generic versions of treatments and, therefore, the model assumes the same persistence for branded and generic.

Table 2. Cost inputs included in the model.

Resources	Daily cost	Source
Drug acquisition costs, per day
Mirabegron 25/50 mg (branded)	$1.46 CAD	Ontario Drug Benefit Formulary^51 (2016); BNF^30 (2016)
Solifenacin 5/10 mg (branded)	$1.69 CAD	Ontario Drug Benefit Formulary^51 (2016); BNF^30 (2016)
Solifenacin 5/10 mg (generic)	$0.42 CAD	Ontario Drug Benefit Formulary^51 (2016); BNF^30 (2016)
Fesoterodine 4/8 mg (branded)	$1.50 CAD	Ontario Drug Benefit Formulary^51 (2016); BNF^30 (2016)
Oxybutynin ER 5 mg (generic)	$0.10 CAD	Ontario Drug Benefit Formulary^51 (2016); BNF^30 (2016)
Oxybutynin IR 10 mg (generic)	$0.20 CAD	Ontario Drug Benefit Formulary^51 (2016); BNF^30 (2016)
Tolterodine ER 4 mg (branded)	$1.96 CAD	Ontario Drug Benefit Formulary^51 (2016); BNF^30 (2016)
Tolterodine ER 4 mg (generic)	$0.49 CAD	Ontario Drug Benefit Formulary^51 (2016); BNF^30 (2016)
Tolterodine IR 2/4 mg (branded)	$1.96 CAD	Ontario Drug Benefit Formulary^51 (2016); BNF^30 (2016)
Tolterodine IR 2/4 mg (generic)	$0.49 CAD	Ontario Drug Benefit Formulary^51 (2016); BNF^30 (2016)
Second-line treatment (weighted)	$1.46 CAD	Ontario Drug Benefit Formulary^51 (2016); Astellas^33 (2016)
Healthcare costs
GP visit^a	$77.20 CAD	Nazir et al.^24 (2015); Ontario Ministry of Health and Long-Term Care^29 (2015)
Specialist (urologist) visit^b	$160.00 CAD	Nazir et al.^24 (2015); Ontario Ministry of Health and Long-Term Care^29 (2015)
Incontinence pad^c	$0.25 CAD^d	Healthwick Canada^31 (2016)
Minimally invasive procedure	$1,034.94 CAD^e	Nazir et al.^24 (2015); Statistics Canada^32 (2016)
Costs of comorbidities, per event
Depression	$109.42 CAD^f	Irwin et al.^21 (2009); Statistics Canada^32 (2016)
UTI	$6.09 CAD^g	Irwin et al.^21 (2009); Statistics Canada^32 (2016)
Other costs
Average hourly wage	$26.30 CAD	Statistics Canada^35 (2016)

^a Visit (n = 1) at treatment initiation and treatment switch.

^b Visit (n = 1.5) at treatment initiation and treatment switch.

^c 2.5 pads/day for persisters, and 5.5 pads/day for non-persisters.

^d $4.99 CAD/pack of 20 Prevail Moderate Bladder Control Pads.

^e Based on 50% onabotA injection and 50% sacral nerve stimulation.

^f Calculation: (€755/12) × 1.509593 × 1.15 = $109.42 CAD.

^g Calculation: (€42/12) × 1.509593 × 1.15 = $6.09 CAD.

GP: general practitioner; ER: extended release; IR: immediate release; UTI: urinary tract infection.

Figure 3. Patient disposition at 1 year for each treatment (100 patients).ER: Extended release; IR: Immediate release.

Table 3. Healthcare resource use over 1 year (per 100 patients).

Treatment	GP visits	Specialist visits	Surgeries	Total pad use	Pads used on treatment	Pads used off treatment
Mirabegron 25/50 mg (branded)	117	175	0.005	74,098	38,452	35,646
Solifenacin 5/10 mg (branded)	120	179	0.005	77,878	35,301	42,577
Solifenacin 5/10 mg (generic)	120	179	0.005	77,878	35,301	42,577
Fesoterodine 4/8 mg (branded)	120	180	0.005	78,303	34,947	43,357
Oxybutynin ER 5 mg (generic)	120	181	0.005	79,225	34,179	45,047
Oxybutynin IR 10 mg (generic)	122	183	0.006	81,669	32,142	49,527
Tolterodine ER 4 mg (branded)	120	180	0.005	78,869	34,475	44,394
Tolterodine ER 4 mg (generic)	120	180	0.005	78,869	34,475	44,394
Tolterodine IR 2/4 mg (branded)	120	180	0.005	78,869	34,475	44,394
Tolterodine IR 2/4 mg (generic)	120	180	0.005	78,869	34,475	44,394

ER: extended release; IR: immediate release.

Table 4. Direct costs over 1 year (per 100 patients).

	Total medication	First-line medication	Second-line medication	Comorbidities	GP visits	Specialist visits	Surgeries	Pads used
Mirabegron 25/50 mg (branded)	$37,424	$31,868	$5,556	$1,456	$9,027	$28,064	$4.74	$18,487
Solifenacin 5/10 mg (branded)	$38,709	$32,073	$6,636	$1,739	$9,227	$28,684	$5.39	$19,431
Solifenacin 5/10 mg (generic)	$14,654	$8,018	$6,636	$1,739	$9,227	$28,684	$5.39	$19,431
Fesoterodine 4/8 mg (branded)	$34,759	$28,001	$6,758	$1,771	$9,248	$28,749	$5.46	$19,537
Oxybutynin ER 5 mg (generic)	$8,794	$1,772	$7,021	$1,840	$9,292	$28,887	$5.59	$19,767
Oxybutynin IR 10 mg (generic)	$10,902	$3,183	$7,719	$2,022	$9,401	$29,227	$5.91	$20,376
Tolterodine ER 4 mg (branded)	$42,753	$35,833	$6,920	$1,813	$9,275	$28,834	$5.54	$19,678
Tolterodine ER 4 mg (generic)	$15,878	$8,959	$6,920	$1,813	$9,275	$28,834	$5.54	$19,678
Tolterodine IR 2/4 mg (branded)	$42,747	$35,828	$6,920	$1,813	$9,275	$28,834	$5.54	$19,678
Tolterodine IR 2/4 mg (generic)	$15,876	$8,957	$6,920	$1,813	$9,275	$28,834	$5.54	$19,678

All figures are CAD.

CAD: Canadian dollar; ER: Extended release; GP: General Practitioner; IR: Immediate release.

Figure 4. Total and disaggregated costs over 1 year for each treatment (100 patients).CAD: Canadian dollar; ER: Extended release; GP: General Practitioner; IR: Immediate release.

Figure 5. Tornado diagram of deterministic sensitivity analysis (mirabegron vs solifenacin 5/10 mg [generic]).

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