Methods: A Markov state-transition model assessed US commercial health-plan and Medicare Advantage perspectives over a 3-year time horizon in an OAB patient population. Transition probabilities between five micturition and five incontinence severity states were derived from a network meta-analysis of 44 trials of oral OAB treatments. Therapy beginning with an oral OAB agent could discontinue or switch to another oral agent and could be followed by tibial nerve stimulation, sacral neuromodulation, or onabotulinumtoxinA. The primary outcome was cost per quality-adjusted life year (QALY). Utilities were mapped from incontinence and micturition frequencies as well as demographics. Based on analysis of data from a large healthcare system, elevated ACB was associated with increased healthcare utilization and probability of cognitive impairment.
Results: From both commercial and Medicare Advantage perspectives, mirabegron was the most clinically effective treatment, while oxybutynin was the least expensive. Tolterodine immediate release (IR) was also on the cost-effectiveness frontier. The analysis estimated costs per QALY of $59,690 and $66,347 for mirabegron from commercial health plan and Medicare Advantage perspectives, respectively, compared to tolterodine IR. Other antimuscarinics were dominated.
Conclusions: This analysis estimated that mirabegron is a cost-effective treatment for OAB from US commercial health plan and Medicare Advantage perspectives, due to fewer projected adverse events and comorbidities, and data suggesting better persistence. 相似文献
The main purpose of this study is to explore the relationships between cultural intelligence (CQ) and organizational commitment in Belt & Road area, with critical consideration given to the moderating effect of cultural distance (CD) on the commensurate relationships. We examined a dataset of 390 international professionals on Chinese cross-border projects in Belt & Road countries. Findings indicate that cognitive CQ has an inverted U-shaped relationship with organizational commitment, while motivational CQ has a positive linear relationship with organizational commitment, and cultural distance moderates the relationships between CQ and commitment such that negative or positive moderation occur contingent on whether the optimal CQ level is reached. Our results suggest the need for identifying an inflection point of individuals’ CQ level to differentiate between the increasing and decreasing trend of organizational commitment in view of the effect of cultural distance. This may help enabling multinationals to leverage expatriates with different levels of CQ to stay committed in multi-cultural environments along the Belt & Road countries.
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