Skip to main content
SpringerLink
Log in

Review of Economic Value Drivers of the Treatment of Overactive Bladder

  • Review Article
  • Published:
PharmacoEconomics Aims and scope Submit manuscript

Abstract

Overactive bladder (OAB) is a symptom-driven condition with economic burden estimated to be on the order of several hundred dollars or euros per patient in some North American and European countries. This work reviews recently published economic models to evaluate how health states are defined, what cost components are considered, and what utility values are used to estimate the cost effectiveness of OAB pharmacotherapies, botulinum toxin, or sacral neuromodulation. It was found that no clear standard exists for determining OAB health states, although most were defined by some measure of incontinence frequency. Costs of physician visits and incontinence pads were included in nearly all models; however, OAB-associated depression and nursing home costs were rarely included, despite being large cost drivers of global economic burden studies. Utility values used in the models ranged from 0.544 to 0.933, highlighting the uncertainty associated with how OAB patients value health-related quality of life. More research is warranted so that health states providing delineations among OAB symptom severity and quality of life are clinically and economically meaningful as well as meaningful to affected patients.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Similar content being viewed by others

References

  1. Irwin DE, Milsom I, Hunskaar S, Reilly K, Kopp Z, Herschorn S, et al. Population-based survey of urinary incontinence, overactive bladder, and other lower urinary tract symptoms in five countries: results of the EPIC study. Eur Urol. 2006;50(6):1306–14.

    Article  PubMed  Google Scholar 

  2. Stewart WF, Van Rooyen JB, Cundiff GW, Abrams P, Herzog AR, Corey R, et al. Prevalence and burden of overactive bladder in the United States. World J Urol. 2003;20(6):327–36.

    PubMed  CAS  Google Scholar 

  3. Milsom I, Abrams P, Cardozo L, Roberts RG, Thuroff J, Wein AJ. How widespread are the symptoms of an overactive bladder and how are they managed? A population-based prevalence study. BJU Int. 2001;87(9):760–6.

    PubMed  CAS  Google Scholar 

  4. Lloyd S, Crawford G, McSkimming P, Grifi M, Greenwell T, Ockrim J. The impact of age, gender and severity of overactive bladder wet on quality of life, productivity, treatment patterns and satisfaction. J Clin Urol. 2017;10(6):513–22.

    Article  Google Scholar 

  5. Wagner TH, Hu TW, Bentkover J, LeBlanc K, Stewart W, Corey R, et al. Health-related consequences of overactive bladder. Am J Manag Care. 2002;8(19 Suppl):S598–607.

    PubMed  Google Scholar 

  6. Liberman JN, Hunt TL, Stewart WF, Wein A, Zhou Z, Herzog AR, et al. Health-related quality of life among adults with symptoms of overactive bladder: results from a US community-based survey. Urology. 2001;57(6):1044–50.

    Article  PubMed  CAS  Google Scholar 

  7. Ellsworth PI. Overactive bladder—etiology, diagnosis, and impact. Medscape. 2015. https://emedicine.medscape.com/article/459502-overview. Accessed 26 Apr 2018.

  8. Irwin DE, Mungapen L, Milsom I, Kopp Z, Reeves P, Kelleher C. The economic impact of overactive bladder syndrome in six western countries. BJU Int. 2009;103(2):202–9.

    Article  PubMed  Google Scholar 

  9. Ganz ML, Smalarz AM, Krupski TL, Anger JT, Hu JC, Wittrup-Jensen KU, et al. Economic costs of overactive bladder in the United States. Urology. 2010;75(3):526–32 (32.e1-18).

    Article  PubMed  Google Scholar 

  10. Association AU. Diagnosis and treatment of overactive bladder (non-neurogenic) in adults: AUA/SUFU guidelines. http://www.auanet.org/education/guidelines/overactive-bladder.cfm. Accessed 11 Feb 2018.

  11. Drake MJ, Nitti VW, Ginsberg DA, Brucker BM, Hepp Z, McCool R, et al. Comparative assessment of the efficacy of onabotulinumtoxinA and oral therapies (anticholinergics and mirabegron) for overactive bladder: a systematic review and network meta-analysis. BJU Int. 2017;120(5):611–22.

    Article  PubMed  CAS  Google Scholar 

  12. Chapple CR, Rechberger T, Al-Shukri S, Meffan P, Everaert K, Huang M, et al. Randomized, double-blind placebo- and tolterodine-controlled trial of the once-daily antimuscarinic agent solifenacin in patients with symptomatic overactive bladder. BJU Int. 2004;93(3):303–10.

    Article  PubMed  CAS  Google Scholar 

  13. Rovner ES, Rackley R, Nitti VW, Wang JT, Guan Z. Tolterodine extended release is efficacious in continent and incontinent subjects with overactive bladder. Urology. 2008;72(3):488–93.

    Article  PubMed  Google Scholar 

  14. Chapple C, Van Kerrebroeck P, Tubaro A, Haag-Molkenteller C, Forst HT, Massow U, et al. Clinical efficacy, safety, and tolerability of once-daily fesoterodine in subjects with overactive bladder. Eur Urol. 2007;52(4):1204–12.

    Article  PubMed  CAS  Google Scholar 

  15. National Collaborating Centre for Women’s and Children’s Health and National Institute for Health and Care Excellence. Clinical Guidelines. Urinary incontinence in women: the management of urinary incontinence in women. London: Royal College of Obstetricians and Gynaecologists (UK); 2013.

    Google Scholar 

  16. Milsom I, Axelsen S, Kulseng-Hansen S, Mattiasson A, Nilsson CG, Wickstrøm J. Cost-effectiveness analysis of solifenacin flexible dosing in patients with overactive bladder symptoms in four Nordic countries. Acta Obstet Gynecol Scand. 2009;88(6):693–9.

    Article  PubMed  CAS  Google Scholar 

  17. Herschorn S, Vicente C, Piwko C. Canadian cost-effectiveness analysis of solifenacin compared to oxybutynin immediate-release in patients with overactive bladder. J Med Econ. 2010;13(3):508–15.

    Article  PubMed  CAS  Google Scholar 

  18. Herschorn S, Nazir J, Ramos B, Hakimi Z. Cost-effectiveness of mirabegron compared to tolterodine ER 4 mg for overactive bladder in Canada. Can Urol Assoc J. 2017;11(3-4):123–30.

    Article  PubMed  PubMed Central  Google Scholar 

  19. Aballéa S, Maman K, Thokagevistk K, Nazir J, Odeyemi IAO, Hakimi Z, et al. Cost effectiveness of mirabegron compared with tolterodine extended release for the treatment of adults with overactive bladder in the United Kingdom. Clin Drug Investig. 2015;35(2):83–93.

    Article  PubMed  Google Scholar 

  20. Nazir J, Maman K, Neine M-E, Briquet B, Odeyemi IA, Hakimi Z, et al. Cost-effectiveness of mirabegron compared with antimuscarinic agents for the treatment of adults with overactive bladder in the United Kingdom. Value Health. 2015;18(6):783–90.

    Article  PubMed  Google Scholar 

  21. Wielage RC, Perk S, Campbell NL, Klein TM, Posta LM, Yuran T, et al. Mirabegron for the treatment of overactive bladder: cost-effectiveness from US commercial health-plan and Medicare Advantage perspectives. J Med Econ. 2016;19(12):1135–43.

    Article  PubMed  Google Scholar 

  22. Cardozo L, Thorpe A, Warner J, Sidhu M. The cost-effectiveness of solifenacin vs fesoterodine, oxybutynin immediate-release, propiverine, tolterodine extended-release and tolterodine immediate-release in the treatment of patients with overactive bladder in the UK National Health Service. BJU Int. 2010;106(4):506–14.

    Article  PubMed  CAS  Google Scholar 

  23. Hassouna MM, Sadri H. Economic evaluation of sacral neuromodulation in overactive bladder: a Canadian perspective. Can Urol Assoc J. 2015;9(79-8):242–7.

    Article  PubMed  PubMed Central  Google Scholar 

  24. Pradelli L, Iannazzo S. Solifenacin in the treatment of overactive bladder syndrome in Italian patients: pharmacoeconomic evaluation. J Med Econ. 2009;12(1):25–35.

    Article  PubMed  Google Scholar 

  25. Hakkaart L, Verboom P, Phillips R, Al MJ. The cost utility of solifenacin in the treatment of overactive bladder. Int Urol Nephrol. 2009;41(2):293–8.

    Article  PubMed  Google Scholar 

  26. Speakman M, Khullar V, Mundy A, Odeyemi I, Bolodeoku J. A cost-utility analysis of once daily solifenacin compared to tolterodine in the treatment of overactive bladder syndrome. Curr Med Res Opin. 2008;24(8):2173–9.

    Article  PubMed  CAS  Google Scholar 

  27. Autiero SW, Hallas N, Betts CD, Ockrim JL. The cost-effectiveness of sacral nerve stimulation (SNS) for the treatment of idiopathic medically refractory overactive bladder (wet) in the UK. BJU Int. 2015;116(6):945–54.

    Article  PubMed  CAS  Google Scholar 

  28. Bertapelle MP, Vottero M, Popolo GD, Mencarini M, Ostardo E, Spinelli M, et al. Sacral neuromodulation and Botulinum toxin A for refractory idiopathic overactive bladder: a cost-utility analysis in the perspective of Italian healthcare system. World J Urol. 2015;33(8):1109–17.

    Article  PubMed  CAS  Google Scholar 

  29. Carlson JJ, Hansen RN, Dmochowski RR, Globe DR, Colayco DC, Sullivan SD. Estimating the cost-effectiveness of onabotulinumtoxinA for neurogenic detrusor overactivity in the United States. Clin Ther. 2013;35(4):414–24.

    Article  PubMed  Google Scholar 

  30. Freemantle N, Khalaf K, Loveman C, Stanisic S, Gultyaev D, Lister J, et al. OnabotulinumtoxinA in the treatment of overactive bladder: a cost-effectiveness analysis versus best supportive care in England and Wales. Eur J Health Econ. 2016;17(7):911–21.

    Article  PubMed  Google Scholar 

  31. Leong RK, de Wachter SG, Joore MA, van Kerrebroeck PE. Cost-effectiveness analysis of sacral neuromodulation and botulinum toxin A treatment for patients with idiopathic overactive bladder. BJU Int. 2011;108(4):558–64.

    Article  PubMed  CAS  Google Scholar 

  32. Arlandis S, Castro D, Errando C, Fernandez E, Jimenez M, Gonzalez P, et al. Cost-effectiveness of sacral neuromodulation compared to botulinum neurotoxin a or continued medical management in refractory overactive bladder. Value Health. 2011;14(2):219–28.

    Article  PubMed  Google Scholar 

  33. Nazir J, Hart W. The cost-effectiveness of solifenacin vs. trospium in the treatment of patients with overactive bladder in the German National Health Service. J Med Econ. 2014;17(6):408–14.

    Article  PubMed  CAS  Google Scholar 

  34. Hart WM, Abrams P, Munro V, Retsa P, Nazir J. Cost-effectiveness analysis of solifenacin versus oxybutynin immediate-release in the treatment of patients with overactive bladder in the United Kingdom. J Med Econ. 2013;16(10):1246–54.

    Article  PubMed  Google Scholar 

  35. Armstrong EP, Malone DC, Bui CN. Cost-effectiveness analysis of anti-muscarinic agents for the treatment of overactive bladder. J Med Econ. 2012;15(suppl 1):35–44.

    Article  PubMed  Google Scholar 

  36. Arlandis-Guzman S, Errando-Smet C, Trocio J, Arumi D, Rejas J. Cost-effectiveness analysis of antimuscarinics in the treatment of patients with overactive bladder in Spain: a decision-tree model. BMC Urol. 2011;11(1):9.

    Article  PubMed  PubMed Central  Google Scholar 

  37. Angulo JC, Valpas A, Rejas J, Linden K, Kvasz M, Snedecor SJ. Cost effectiveness of fesoterodine and tolterodine for the treatment of overactive bladder with urge urinary incontinence in Spain and Finland. Clin Drug Investig. 2014;34(5):297–307.

    Article  PubMed  Google Scholar 

  38. Hay SI, Abajobir AA, Abate KH, Abbafati C, Abbas KM, Abd-Allah F, et al. Global, regional, and national disability-adjusted life-years (DALYs) for 333 diseases and injuries and healthy life expectancy (HALE) for 195 countries and territories, 1990-2016: a systematic analysis for the Global Burden of Disease Study. Lancet. 2016;390(1):1260–344.

    Google Scholar 

  39. Nazir J, Posnett J, Walker A, Odeyemi IA, Hakimi Z, Garnham A. Economic evaluation of pharmacological treatments for overactive bladder from the perspective of the UK National Health Service. J Med Econ. 2015;18(5):390–7.

    Article  PubMed  Google Scholar 

  40. Coyne KS, Wein A, Nicholson S, Kvasz M, Chen CI, Milsom I. Economic burden of urgency urinary incontinence in the United States: a systematic review. J Manag Care Pharm. 2014;20(2):130–40.

    PubMed  Google Scholar 

Download references

Acknowledgements

The author would like to acknowledge Varun Ektare, Vardhaman Patel, and Alexandra Flores for critical review and feedback on this manuscript.

Author information

Authors and Affiliations

  1. Pharmerit International, 4350 East West Hwy, Suite 1110, Bethesda, MD, 20814, USA

    Sonya J. Snedecor

Authors
  1. Sonya J. Snedecor
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Sonya J. Snedecor.

Ethics declarations

Funding

The author received no specific funding for this work.

Conflict of interest

Sonya J. Snedecor has no current conflicts of interests to declare; she is an employee of Pharmerit International, which has received funding in the past from Pfizer Inc., the manufacturer of tolterodine and fesoterodine.

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Snedecor, S.J. Review of Economic Value Drivers of the Treatment of Overactive Bladder. PharmacoEconomics 36, 1083–1092 (2018). https://doi.org/10.1007/s40273-018-0663-0

Download citation

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s40273-018-0663-0

Search

Navigation