Clinical and economic impact of mirabegron compared with antimuscarinics for the treatment of overactive bladder in Canada

<p><b>Background:</b> The <i>β</i>₃-adrenoceptor agonist, mirabegron, and antimuscarinic agents provide similar efficacy for the treatment of overactive bladder (OAB), but mirabegron appears to be associated with better persistence, perhaps due to an absence of anticholinergic side-effects. This study estimated the expected costs associated with the management of OAB in Canada from a societal perspective by utilizing real-world evidence.</p> <p><b>Methods:</b> An economic model with monthly cycles and a 1-year time horizon was developed to depict a treatment pathway for a hypothetical cohort of 100 patients with OAB. At model entry, patients receive mirabegron or an antimuscarinic. Patients who do not persist may switch treatment, undergo a minimally invasive procedure, or remain symptomatic (uncontrolled). The model includes direct costs (e.g. physician visits) and indirect costs (e.g. lost productivity). A one-way univariate sensitivity analysis assessed a ±20% variation in each of the key model inputs.</p> <p><b>Results:</b> At 1 year, a greater proportion of patients persisted on treatment with mirabegron compared with antimuscarinics (33% vs 15–23%), and a smaller proportion switched treatment (17% vs 20–22%). The number of healthcare visits (292 vs 299–304), pads used (74,098 vs 77,878–81,669), and work hours lost (4,497 vs 5,372–6,249) were all lower for mirabegron vs antimuscarinics. The estimated total annual cost of treatment per patient with mirabegron was $2,127.46 Canadian dollars (CAD) ($5.82 CAD/day) compared with $2,150.20–$2,496.69 CAD ($5.89–$6.84 CAD/day) for antimuscarinics. The one-way sensitivity analysis indicated the results are robust.</p> <p><b>Conclusions:</b> Improved persistence observed in routine clinical practice with mirabegron appears to translate into benefits of reduced healthcare resource use, and lower direct and indirect costs of treatment compared with antimuscarinics. Overall, these data suggest that mirabegron may offer clinical and economic benefits for the management of patients with OAB in Canada.</p

Revue des architectes français : organe corporatif paraissant les 1er et 15 de chaque mois

01 octobre 19431943/10/01 (A3,N55)-1943/10/15 (A3,N56)

Additional file 4: Table S4. of Landscape genomics: natural selection drives the evolution of mitogenome in penguins

Significant values of GLM and Mantel Test for Ka/Ks ratio and nucleotide diversity (π) for each gene and environmental data (SST, CHL, COM) at different class distance. (DOCX 26 kb

Study area.

<p>Eleven study sites, grouped into four study areas in Southern Chile, between latitude 39°-45° S. Area 1, represents an Andean foothill ecosystem (1:Liquiñe, 2:Neltume, 3:Choshuenco, 4:Todos los Santos); area 2, represents a marine coastal ecosystem (5:Maullín, 7:Puyuhuapi, 8:Puerto Cisnes, 9:Rio-Cisnes); area 3, represents Southern Andean mountain valleys (6:Palena, 10:Rio-Cisnes-Alto); area 4, represents an island (11:Magdalena Island). Red: High degree of presence human-domestic cat. Orange: Medium degree of presence human-domestic cat. Green: Low degree of presence human-domestic cat.</p

Additional file 3: Table S3. of Landscape genomics: natural selection drives the evolution of mitogenome in penguins

Example of matrix between the environmental distance (ENDIST), chlorophyll (CHL) in this example, and the the Ka/Ks. Then environmental data (CHL) were grouped in three class distances for the GLM and Mantel tests. (DOCX 35 kb

Effects of landscape variables on seroprevalence.

<p>A) Observed seroprevalence in mink and otter by study site. B) Observed seroprevalence by degree of presence of domestic cat. C) Observed seroprevalence by habitat. * Number above bars indicate sample size. Y axis show mean seroprevalence.</p

Seroprevalence of <i>Toxoplasma gondii</i>.

<p>Data from 11 study sites with varying degrees of domestic cat presence, (NS = Not samples).</p

Variable importance analysis performed using random forest.

<p>The set of four categorical variables (age, species, habitat type, sex) and two continuous variables (human presence and cat density) used for classification the seropositivity to <i>Toxoplasma gondii</i>. Variables are ordered by their importance from top to bottom as estimated by the random forest model and denoted using an Gini index ranging from 0 to 100.</p

Land cover change and <i>Toxoplasma gondii</i> reports.

<p>Positive (red crosses) and negative (white crosses) reports of <i>T</i>. <i>gondii</i> in wildlife compared with vegetation change represented in the second principal component of the EVI 2002 and 2012. Change was denoted as areas of vegetation gain (green) and stability (light blue), and considerable vegetation loss (dark blue).</p