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Inicio Actas Urológicas Españolas (English Edition) Use of health care resources and associated costs in non-institutionalized vulne...
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Vol. 38. Issue 8.
Pages 530-537 (October 2014)
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Vol. 38. Issue 8.
Pages 530-537 (October 2014)
Original article
Use of health care resources and associated costs in non-institutionalized vulnerable elders with overactive bladder treated with antimuscarinic agents in the usual medical practice
Uso de recursos sanitarios y costes asociados en pacientes ancianos vulnerables no institucionalizados con vejiga hiperactiva tratados con antimuscarínicos en la práctica médica habitual
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A. Sicras-Mainara,
Corresponding author
asicras@bsa.cat

Corresponding author.
, J. Rejas-Gutiérrezb, R. Navarro-Artiedac, A. Aguado-Jodard, A. Ruíz-Torrejóne
a Dirección de Planificación, Badalona Serveis Assistencials SA, Badalona, Barcelona, Spain
b Health Economics and Outcomes Research, Pfizer SLU, Alcobendas, Madrid, Spain
c Documentación Médica, Hospital Germans Trias i Pujol, Badalona, Barcelona, Spain
d CAP Sagrada Familia, Consorci Sanitari Integral, Barcelona, Spain
e Dirección de Atención Primaria, Servicio Balear de Salud, Ib-Salut, Mallorca, Spain
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Figures (2)
Tables (4)
Table 1. Resource use and unit costs.
Table 2. Baseline characteristics of the studied series.
Table 3. Description of the treatment, compliance and persistence.
Table 4. Resource use and health care costs per patient/year according to the study groups. Corrected modelsa
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Abstract
Objective

To evaluate the use of resources and health costs in vulnerable elderly institutionalized patients with overactive bladder (OAB) treated with fesoterodine, tolterodine or solifenacin in routine medical practice.

Material and methods

A multicenter retrospective study, from the records of patients treated during 2008–2010 in three geographical locations and starting treatment with antimuscarinic (fesoterodine, solifenacin and tolterodine) for OAB. The attribute of vulnerability was based on collecting at least 3 of the Vulnerable Elders Survey criteria-13, age>75 years, poor/average age for health and difficulty in at least one daily physical activity. Main measures: morbidity, persistence and resource use and costs. Monitoring of patients was conducted over 52 weeks. A general linear model with covariates and bootstraping (1000) at random was used to construct the 95% CI of the cost differences between drugs.

Results

Records of 552 patients (50.8% women, mean age: 80.2 years) were analyzed. Treated with fesoterodine (N=58), solifenacin (N=252) or tolterodine (N=212). The use of absorbent was 20.7%, 29.4% and 33.0% (p=0.186), respectively. Persistence to treatment was slightly greater with fesoterodine. The patient healthcare costs/year were lower with fesoterodine, €1775 (1550–2014) vs. solifenacin €2062 (1911–2223) and tolterodine €2149 (1978–2307), p=0.042, as a result of lower utilization visits and concomitant medication.

Conclusions

Despite the potential limitations of the study, the vulnerable elderly non institutionalized patients with OAB treated with fesoterodine, compared to solifenacin or tolterodine were associated with lower resource utilization and healthcare costs.

Keywords:
Overactive bladder
Antimuscarinic
Resource use
Costs
Vulnerable elderly
Resumen
Objetivo

Evaluar el uso de recursos y costes sanitarios en pacientes ancianos vulnerables no institucionalizados con vejiga hiperactiva (VH) tratados con fesoterodina, solifenacina o tolterodina en la práctica médica habitual.

Material y métodos

Estudio multicéntrico, retrospectivo, realizado a partir de los registros de pacientes atendidos durante 2008–2010 en 3 localidades geográficas y que iniciaron tratamiento con antimuscarínicos (fesoterodina, solifenacina y tolterodina) para la VH. El atributo de vulnerabilidad se basó en reunir, al menos, 3 de los criterios del Vulnerable-Elders Survey-13; edad>75 años, salud pobre/normal para la edad y alguna dificultad en al menos una actividad física diaria. Principales medidas: comorbilidad, persistencia y uso de recursos y costes. El seguimiento de los pacientes se realizó durante 52 semanas. Se utilizó un modelo lineal general con covariables y remuestreo (1000) aleatorio para construir el IC 95% de las diferencias de costes entre fármacos.

Resultados

Se analizaron registros de 552 pacientes (50,8% mujeres, edad media: 80,2 años), tratados con fesoterodina (n=58), solifenacina (n=252) o tolterodina (n=212). El uso de absorbentes fue del 20,7, 29,4 y 33,0% (p=0,186), respectivamente. La persistencia al tratamiento fue ligeramente mayor con fesoterodina. Los costes sanitarios paciente/año fueron inferiores con fesoterodina, 1775€ (1550–2014) vs. solifenacina 2062€ (1911–2223) y tolterodina 2149€ (1978–2307), p=0,042, como consecuencia de una menor utilización de visitas y medicación concomitante.

Conclusiones

A pesar de las posibles limitaciones del estudio, los pacientes ancianos vulnerables no institucionalizados con VH tratados con fesoterodina, en comparación con solifenacina o tolterodina, se asociaron a una menor utilización de recursos y costes sanitarios.

Palabras clave:
Vejiga hiperactiva
Antimuscarínicos
Uso de recursos
Costes
Ancianos vulnerables

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