The impact of persistence with mirabegron usage versus switching to onabotulinumtoxinA on healthcare costs and resource utilization in patients with overactive bladder in the United States

Aims To compare healthcare costs and resource utilization in patients with overactive bladder (OAB) in the United States who switch from mirabegron to onabotulinumtoxinA (onabotA) with those who persist on mirabegron. Materials and methods A retrospective observational claims analysis of the OptumHealth Administrative Claims database conducted between April 1, 2012 and September 30, 2015 used medical and pharmacy claims to identify patients with at least one OAB diagnosis who switched from mirabegron to onabotA (onabotA group) or persisted on mirabegron for at least 180 days (mirabegron persisters). Propensity score weighting was used to balance baseline characteristics that were associated with increased healthcare expenditures across treatment groups. Multivariate analyses assessed the impact of switching and persistence on all-cause and OAB-related healthcare costs and resource utilization in the year following each patient's index date. Results 449 patients were included in this study: 54 patients were included in the onabotA group, and 395 patients were included in the mirabegron persister group. Compared with the mirabegron persister patients, the onabotA patients observed significantly higher OAB-related total costs ($5,504 vs. $1,772, p<0.001), OAB-related medical costs ($5,033 vs. $351, p<0.001), sacral neuromodulation costs ($865 vs. $60, p = 0.017) and outpatient costs ($17,385 vs. $9,035, p = 0.009), and more OAB-related medical visits (6.0 vs. 1.9, p<0.001). OnabotA patients had lower OAB-related prescription costs ($470 vs. $1,421, p<0.001) and fewer OAB-related pharmacy claims (1.6 vs. 5.0, p<0.001). There were no significant differences in all-cause total medical or prescription costs. Limitations This study was a retrospective analysis using claims data that only included patients with commercial health coverage or Medicare supplemental coverage. Accuracy of the diagnosis codes and the generalizability of the results to other OAB populations are limited. The study was not designed to determine the impact of OAB treatments on the economic outcomes examined. Conclusions OAB patients who persisted on mirabegron treatment for at least 180 days had lower OAB-related healthcare costs and resource utilization compared with those who switched to onabotA.

Journal of medical economics. 2017 Aug 14 [Epub ahead of print]

Daniel Bin Ng, Robert Espinosa, Scott J Johnson, David Walker, Katherine Gooch

a Medical Affairs, Americas, Astellas Pharmaceutical Global Development , Northbrook , IL., b Medicus Economics LLC , Milton , MA.

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