Beta-3 Agonists Versus Anticholinergics: A Cost-effectiveness Analysis

Importance Medical treatment for overactive bladder (OAB) includes beta-3 agonists and anticholinergic medications; the latter of which has been associated with an increased risk of dementia. With dementia risks included, the cost-effectiveness of these medications has not been determined. Objective The objective of this study was to evaluate 10-year costs, quality of life, and cost-effectiveness comparing beta-3 agonists to anticholinergics. Study Design A Monte Carlo microsimulation (n=10,000) modeled treatment pathways of anticholinergics versus beta-3 agonists. Both strategies included opportunities to transition to a second same-class medication, third-line therapies, or discontinue treatment. Model inputs were derived from national databases and published literature. Quality-adjusted life-years (QALYs), cost, and incremental cost-effectiveness ratios (ICERs) were modeled from the health care perspective. Secondary outcomes evaluated the marginal increase in the incidence of dementia, time with dementia, and dementia-associated treatment cost. Results Among patients using anticholinergics, an additional 1.9% developed dementia compared with beta-3 agonists, incurring an additional $250,092 per patient over 10 years. Beta-3 agonists were cost-effective (ICER=$9,132.26/QALY). Furthermore, beta-3 agonists were the dominant strategy, resulting in lower costs and higher QALYs, in 35.9% (3,586/10,000) of patients, compared with 32.3% utilizing anticholinergics. Conclusions Despite the increased medication cost of beta-3 agonists, the overall costs of treating OAB are comparable over 10 years. Broadened accessibility and coverage of these cost-effective treatments reduce risks and costs associated with dementia.