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首页> 外文期刊>BJU international >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.
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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.

机译：在英国国家卫生服务部治疗膀胱过度活动症患者中，索非那新与非索罗定，奥昔布宁速释，丙泊灵，托特罗定缓释和托特罗定即释的成本效益比较。

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OBJECTIVE: To assess the cost-effectiveness of solifenacin vs other antimuscarinic strategies commonly used in UK clinical practice, based on the results of a recent published review. METHODS: Overactive bladder (OAB) syndrome is characterized by symptoms of urgency, frequency, incontinence and nocturia. Pharmacological treatment comprises oral antimuscarinic agents, which are divided into older-generation treatments, including oxybutynin, and new-generation treatments, comprising solifenacin, tolterodine, darifenacin and fesoterodine. The latter have reduced central nervous system penetration and have better selectivity for the M3 subclass of acetylcholine receptors, resulting in improved tolerability. A recent systematic review and meta-analysis of the efficacy and safety of antimuscarinics provided an opportunity for an economic evaluation of these agents using a rigorous assessment of efficacy. A cost-utility analysis was undertaken using a 1-year decision-tree model. Treatment success was defined separately for urgency, frequency and incontinence, with efficacy data taken from the recent review. Treatment persistence rates were taken from the Information Management System database. Utility values for the calculation of quality-adjusted life-years (QALYs) were taken from published sources. The analysis included costs directly associated with treatment for OAB, i.e. antimuscarinic therapy, consultations with general practitioners, and outpatient contacts. Resource use was based on expert opinion. Costs were reported at 2007/2008 prices. Extensive deterministic and probabilistic analyses were conducted to test the robustness of the base-case results. RESULTS: Solifenacin was associated with the highest QALY gains (per 1000 patients) for all three outcomes of interest, i.e. urgency (712.3), frequency (723.1) and incontinence (695.0). Solifenacin was dominant relative to fesoterodine, tolterodine extended-release (ER) and tolterodine immediate-release (IR), and cost-effective relative to propiverine ER for urgency, frequency and incontinence. Solifenacin was not found to be cost-effective relative to oxybutynin IR for the frequency and incontinence outcomes, with an incremental cost-effectiveness ratio of > pound30,000/QALY threshold. CONCLUSIONS: Solifenacin provided the greatest clinical benefit and associated QALYs for all three outcomes of interest across all therapies considered, and to be either dominant or cost-effective relative to all other new-generation agents, but not cost-effective relative to oxybutynin for frequency and incontinence.
机译：目的：根据最近发表的综述的结果，评估索利那新与其他在英国临床实践中常用的抗毒蕈碱策略相比的成本效益。方法：膀胱过度活动症（OAB）的特征是尿急，尿频，尿失禁和夜尿症状。药理学治疗包括口服抗毒蕈碱药，分为奥昔布宁等较早的治疗和包括索非那新，托特罗定，达利福星和非索罗定的新一代治疗。后者降低了中枢神经系统的渗透性，并对乙酰胆碱受体的M3亚类具有更好的选择性，从而提高了耐受性。最近关于抗毒蕈碱药物功效和安全性的系统综述和荟萃分析为使用严格的功效评估对这些药物进行经济评估提供了机会。使用一年的决策树模型进行了成本-效用分析。根据尿急，频率和大小便失禁分别定义了治疗成功率，其疗效数据来自最近的综述。从信息管理系统数据库中获得治疗持续率。用于计算质量调整生命年（QALYs）的效用值来自公开来源。分析包括与OAB治疗直接相关的费用，即抗毒蕈碱治疗，与全科医生会诊以及门诊联系​​。资源使用基于专家意见。费用按2007/2008年价格报告。进行了广泛的确定性和概率分析，以测试基本案例结果的稳健性。结果：索利那新与所有感兴趣的三个结局（即尿急（712.3），频率（723.1）和尿失禁（695.0））的最高QALY增益（每1000位患者）相关。相对于非索罗定，托特罗定缓释剂（ER）和托特罗定立即释放剂（IR），索非那新占主导地位，相对于普罗瑞汀ER而言，尿急，频发和尿失禁的成本效益更高。相对于奥昔布宁IR而言，在频率和失禁结果方面，索非那新的成本效益并不高，其成本效益比增量大于30,000英镑/ QALY阈值。结论：索非那新在所有考虑的所有治疗方法中对所有三种感兴趣的结局均提供了最大的临床获益和相关的QALY，相对于所有其他新一代药物而言，索利那新占主导地位或具有成本效益，但相对于奥昔布宁而言，其频率却不具有成本效益和失禁。

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