Cost–effectiveness of novel therapies for overactive bladder

Abstract

Overactive bladder is a difficult to treat condition affecting a large proportion of adults resulting in considerable economic impact to society. First-line treatments such as behavioral therapy or antimuscarinic medication are frequently not effective in adequately controlling symptoms or have intolerable side effects. Patients subsequently require second-line therapy including, sacral neuromodulation through either posterior tibial nerve stimulation or sacral nerve stimulation or intra-detrusor injection of Onabotulinumtoxin-A. Mirabegron, a relatively new drug in a separate class, is also employed in the treatment of overactive bladder. The question of which novel therapy to initiate depends on several factors including patient preference, effectiveness and cost. The purpose of this review is to present and discuss the most recent studies pertaining to the cost–effectiveness of novel therapies for overactive bladder.

Keywords::

• anticholinergic
• antimuscarinic
• botox
• botulinum neurotoxin A
• decision analysis
• interstim
• mirabegron
• posterior tibial nerve stimulation
• sacral nerve stimulation
• urgency incontinence

Financial & competing interests disclosure

The authors have no 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. This includes employment, consultancies, honoraria, stock ownership or options, expert testimony, grants or patents received or pending or royalties.

No writing assistance was utilized in the production of this manuscript.

Key issues

• Traditional first-line therapy for overactive bladder (OAB) includes lifestyle and behavioral modifications usually combined with antimuscarinic medications such as oxybutynin, tolterodine, trospium, solifenacin, darifenacin or fesoterodine.

• Novel OAB therapies include mirabegron, neuromodulation through either posterior tibial nerve stimulation or sacral nerve stimulation with the InterStim device, or intra-detrusor injection of onabotulinumtoxin-A.

• Novel therapies for OAB are generally cost-effective when compared with standard treatment.

• Fewer studies in the literature have compared novel therapies for OAB with each other.

• Differing time horizons and perspectives employed in cost–effectiveness analyses may have a large impact on the conclusions drawn with respect to novel therapies.

• The fact that a given therapy is cost-effective among several studies does not necessarily mean that it warrants employment in all patients with OAB.

• Other patient-centered outcome considerations may take precedent over costs and utilities when considering which OAB therapy to employ for a given patient.