Cost Effectiveness Analysis Of Using Beta-3 Agonists Over Anticholinergics For Treatment Of Overactive Bladder In Reducing Risk And Cost Of Anticholinergic-Associated Cognitive Decline.

INTRODUCTION: Anticholinergic (Ach) medications, a mainstay in the treatment of overactive bladder (OAB), are increasingly linked to incident dementia. Beta-3 agonists (B3A) have emerged as an alternative with a more favorable side-effect profile, especially in elderly patients. This study evaluated whether treating OAB with B3A instead of Ach is cost-effective, accounting for the long-term clinical and economic impact of Ach-associated dementia. METHODS: A cost-effectiveness analysis was conducted from the health care sector perspective using a Markov microsimulation model comparing Ach and B3A over a 15-year horizon. Model inputs included costs, utilities, and probabilities of health states and adverse events associated with untreated OAB, pharmacotherapy, and minimally invasive therapies. Health states transitioned between untreated OAB, Ach or B3A, minimally invasive therapy, and dementia. Analysis was performed with TreeAge. RESULTS: Over 15 years, total health care costs were $97,000 for Ach versus $90,961 for B3A, and total QALYs were 8.65 versus 8.79, respectively. Sensitivity analysis revealed that B3A alone, compared to Ach alone or Ach followed by B3A, is the dominant strategy, and this held when inputs were varied across their ranges. CONCLUSIONS: B3A are cost-saving and more effective than Ach for OAB, largely driven by the elevated dementia risk associated with Ach exposure and the substantial costs and diminished quality of life inherent to dementia. Although clinical guidelines favor eliminating step therapy, many payers still mandate an Ach trial before approving B3A. The long-term burden of Ach-associated dementia exceeds the lower upfront cost of Ach, making B3A more cost-effective overall.