Cost-Utility Analysis of Mirabegron Compared to Solifenacin in the Treatment of Overactive Bladder (OAB) in Iran

Background: Overactive bladder (OAB) is a symptomatic condition characterized by urinary urgency with or without incontinence, usually associated with frequent daytime urination, enuresis, and nocturia. Objectives: This economic evaluation was aimed at assessing the cost-effectiveness of mirabegron versus solifenacin in the treatment of OAB patients from a payer’s perspective in Iran. Methods: A Markov model with a 5-year time horizon was used. The model consisted of five health states, and OAB patients with an average age of 60 years entered the cycle from the persistent state. Transition probabilities were based on published trials, clinical judgments, and expert opinions. Resource use and costs, including those for medications and adverse events, were extracted from the literature and tariff book, and all costs are presented in 2019 US dollars with a 5% discount rate for the costs and utilities. The incremental cost-effectiveness ratio (ICER) and quality-adjusted life-years (QALYs) were computed for medications, and sensitivity analyses were used to test the robustness of the results. Results: Average per-patient treatment costs were $24,720.7 and $24,668.6 for mirabegron and solifenacin, respectively. Mirabegron was expected to produce higher QALYs than solifenacin (3.20 vs. 3.19). Mirabegron had an ICER of $531.3 over solifenacin, lower than the willingness-to-pay (WTP) threshold. The probabilistic analysis showed mirabegron cost-effectiveness in 80% of simulations at the WTP of $2709/QALY. Conclusions: Compared to solifenacin, mirabegron was more cost-effective in OAB patients in the Iranian healthcare system.