Health economics perspective of fesoterodine, tolterodine or solifenacin as first-time therapy for overactive bladder syndrome in the primary care setting in Spain

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Abstract

Background

Overactive bladder (OAB) is associated with high healthcare costs, which may be partially driven by drug treatment. There is little comparative data on antimuscarinic drugs with respect to resource use and costs. This study was conducted to address this gap and the growing need for naturalistic studies comparing health economics outcomes in adult patients with OAB syndrome initiating treatment with different antimuscarinic drugs in a primary care setting in Spain.

Methods

Medical records from the databases of primary healthcare centres in three locations in Spain were assessed retrospectively. Men and women ≥18 years of age who initiated treatment with fesoterodine, tolterodine or solifenacin for OAB between 2008 and 2010 were followed for 52 weeks. Healthcare resource utilization and related costs in the Spanish National Health System were compared. Comparisons among drugs were made using multivariate general linear models adjusted for location, age, sex, time since diagnosis, Charlson comorbidity index, and medication possession ratio.

Results

A total of 1,971 medical records of patients (58.3% women; mean age, 70.1 [SD:10.6] years) initiating treatment with fesoterodine (n = 302), solifenacin (n = 952) or tolterodine (n = 717) were examined. Annual mean cost per patient was €1798 (95% CI: €1745; €1848). Adjusted mean (95% bootstrap CI) healthcare costs were significantly lower in patients receiving fesoterodine (€1639 [1542; 1725]) compared with solifenacin (€1780 [€1699; €1854], P = 0.022) or tolterodine (€1893 [€1815; €1969], P = 0.001). Cost differences occurred because of significantly fewer medical visits, and less use of absorbent products and OAB-related concomitant medication in the fesoterodine group.

Conclusions

Compared with solifenacin and tolterodine, fesoterodine was a cost-saving therapy for treatment of OAB in the primary care setting in Spain.

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Most cited references 37

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How should cost data in pragmatic randomised trials be analysed?

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Long-term persistence in use of statin therapy in elderly patients.

Joshua S Benner, Robert J Glynn, Helen Mogun … (2015)

Knowledge of long-term persistence with 3-hydroxy-3-methylglutaryl coenzyme A reductase inhibitor (statin) therapy is limited because previous studies have observed patients for short periods of time, in closely monitored clinical trials, or in other unrepresentative settings. To describe the patterns and predictors of long-term persistence with statin therapy in an elderly US population. Retrospective cohort study including 34 501 enrollees in the New Jersey Medicaid and Pharmaceutical Assistance to the Aged and Disabled programs who were 65 years of age and older, initiated statin treatment between 1990 and 1998, and who were followed up until death, disenrollment, or December 31, 1999. Proportion of days covered (PDC) by a statin in each quarter during the first year of therapy and every 6 months thereafter; predictors of suboptimal persistence during each interval (PDC <80%) were identified using generalized linear models for repeated measures. The mean PDC was 79% in the first 3 months of treatment, 56% in the second quarter, and 42% after 120 months. Only 1 patient in 4 maintained a PDC of at least 80% after 5 years. The proportion of patients with a PDC less than 80% increased in a log-linear manner, comprising 40%, 61%, and 68% of the cohort after 3, 12, and 120 months, respectively. Independent predictors of poor long-term persistence included nonwhite race, lower income, older age, less cardiovascular morbidity at initiation of therapy, depression, dementia, and occurrence of coronary heart disease events after starting treatment. Patients who initiated therapy between 1996-1998 were 21% to 25% more likely to have a PDC of at least 80% than those who started in 1990. Persistence with statin therapy in older patients declines substantially over time, with the greatest drop occurring in the first 6 months of treatment. Despite slightly better persistence among patients who began treatment in recent years, long-term use remains low. Interventions are needed early in treatment and among high-risk groups, including those who experience coronary heart disease events after initiating treatment.

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The assessment of refill compliance using pharmacy records: methods, validity, and applications.

Ricardo A. Prochazka, F. Steiner (1996)

The refill records of computerized pharmacy systems are used increasingly as a source of compliance information. We reviewed the English-language literature to develop a typology of methods for assessing refill compliance (RC), to describe the epidemiology of compliance in obtaining medications, to identify studies that attempted to validate RC measures, to describe clinical features that predicted RC, and to describe the uses of RC measures in epidemiologic and health services research. In most of the 41 studies reviewed, patients obtained less medication than prescribed; gaps in treatment were common. Of the studies that assessed the validity of RC measures, most found significant associations between RC and other compliance measures, as well as measures of drug presence (e.g., serum drug levels) or physiologic drug effects. Refill compliance was generally not correlated with demographic characteristics of study populations, was higher among drugs with fewer daily doses, and was inconsistently associated with the total number of drugs prescribed. We conclude that, though some methodologic problems require further study, RC measures can be a useful source of compliance information in population-based studies when direct measurement of medication consumption is not feasible.

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Author and article information

Contributors

Antoni Sicras-Mainar

Javier Rejas

Ruth Navarro-Artieda

Alba Aguado-Jodar

Amador Ruiz-Torrejón

Jordi Ibáñez-Nolla

Marion Kvasz

Journal

Journal ID (nlm-ta): BMC Urol

Journal ID (iso-abbrev): BMC Urol

Title: BMC Urology

Publisher: BioMed Central

ISSN (Electronic): 1471-2490

Publication date Collection: 2013

Publication date (Electronic): 21 October 2013

Volume: 13

Page: 51

Affiliations

[1 ]Directorate of Planning, Badalona Serveis Assistencials SA, Calle Gaietà Soler, 6-8 entlo, CP 08911 Badalona, Barcelona, Spain

[2 ]Health Economics and Outcomes Research, Pfizer SLU, Alcobendas, Madrid, Spain

[3 ]Medical Information Department, Hospital Germans Trias i Pujol, Badalona, Spain

[4 ]CAP Sagrada Familia, Barcelona, Spain

[5 ]Primary Health Care Directorate, 1ib-Salut, Mallorca, Spain

[6 ]Directorate of Badalona Serveis Assistencials SA, Hospital Municipal de Badalona, Badalona, Barcelona, Spain

[7 ]Health Economics and Outcomes Research, Pfizer PIO, Paris, France

Article

Publisher ID: 1471-2490-13-51

DOI: 10.1186/1471-2490-13-51

PMC ID: 4015546

PubMed ID: 24144225

SO-VID: d65d070b-4d68-4f9c-b74f-f748b35c238b

License:

This is an open access article distributed under the terms of the Creative Commons Attribution License ( http://creativecommons.org/licenses/by/2.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

Health economics perspective of fesoterodine, tolterodine or solifenacin as first-time therapy for overactive bladder syndrome in the primary care setting in Spain

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Most cited references 37

How should cost data in pragmatic randomised trials be analysed?

Long-term persistence in use of statin therapy in elderly patients.

The assessment of refill compliance using pharmacy records: methods, validity, and applications.

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