BERKELEY, CA (UroToday.com) - Overactive bladder syndrome (OAB) is a chronic disease characterized by urinary urgency, with or without urge incontinence, frequency, and nocturia. The prevalence of OAB in the general population is reported to be 14-16%. Anti-muscarinic agents are considered the first-line pharmacological treatment for the management of OAB. Although a long lasting therapy is indicated to reach a better control of symptoms, a high percentage of patients discontinue the cure after a few months. Previous studies have been carried out in the attempt to elucidate the economic impact of anti-muscarinic agents both at the beginning of the treatment and in the long lasting regimen. In this study, our attempt is to investigate whether the cost of solifenacin succinate (SS) may influence the long-lasting regimen and patients’ drug efficacy.
70 consecutive women, mean age 57-years-old (range 35-81), with symptoms of OAB, were enrolled in this randomized controlled study. All women underwent a detailed clinical evaluation. 35 patients (group A) received SS 5 mg by the urologist without any cost; they were instructed to take the drug once daily for 4 months. Differently, in group B ( 35 patients), women need to buy the drug, which was administrated as in the group A. Frequency, nocturia, urge incontinence, and voided volume were evaluated by a 3-day micturition diary. Overactive bladder questionnaire short form (OAB-qSF) was used to assess the impact of symptoms on patients’ quality of life. Urgency was assessed by patients’ perception of intensity of urgency (PPIUS). Improvement was evaluated with the Patient Global Impression of Improvement questionnaire (PGI-I).
A greater number of patients discontinued SS in group B, who need to buy the drug (34 vs 24 patients). In both groups we observed a significant improvement of all symptoms after 4 months of treatment. In the comparison of post-treatment results, we noticed a statistically significant difference between the 2 groups for all items except for urge incontinence, with a greater improvement in group A. Furthermore group A showed a significant improvement both in the perception of urgency (PPIUS) and on the quality of life in comparison to group B. Impression of improvement showed a statistical significant difference, with better results, in patients of group A.
Our results seem to support the hypothesis that the cost of the anti-muscarinic is partly involved in an incomplete adhesion to the treatment protocol of several patients, thus reducing the efficacy. Therefore, the cost of the anti-muscarinic may be responsible for both early discontinuation of treatment and incomplete adherence to therapy, with unsatisfactory results on symptoms and an incorrect assessment of the effectiveness of the drug by the urologist.
Carlo Vecchioli-Scaldazza,1 Carolina Morosetti,2 Gianna Pace,1 Berouz Azizi,1 Willy Giannubilo,1 and Vincenzo Ferrara1 as part of Beyond the Abstract on UroToday.com. This initiative offers a method of publishing for the professional urology community. Authors are given an opportunity to expand on the circumstances, limitations etc... of their research by referencing the published abstract.
1Department of Urology, 2Clinical Pathology, ASUR, Area vasta n° 2 Jesi, Italy.