Overactive bladder in female patients over 60 years old: therapeutical alternatives for a cost-effectiveness analysis in Brazil

Abstract

Considering the problem under analysis vis-à-vis the need for efficient resource allocation, the study takes into account the most workable therapeutical alternatives in the Brazilian context. A study in this area of knowledge requires a sequence of steps. This is a study that has as its premise a synthesis of knowledges. Data bases consulted were: MedLine, SciELO, Cochrane, IBGE (Brazilian Geography and Statistics Institute) and DATASUS (Information System of the Sistema Único de Saúde - Unified Health System).Key words used were: health economic assessment, health economic evaluation, cost-effectiveness, methodology, guidelines, approach, framework, urinary incontinence, overactive bladder, prevalence, population based study, community-dwelling, overactive bladder management, efficacy, effectiveness and adverse effect. The only Brazilian study published about overactive bladder prevalence estimated it at 18,9%. The estimated number of women with Overactive Bladder in Brazil is 1.428.236 for the year 2008.Therapeutical alternatives are: oxibutinine, tolterodine, darifenacina, electrostimulation, cinesiotherapy, biofeedback, combined therapy, neuromodulation and botulin. In our context the most common methodological proposals for elaborating economical assessments are those described by Drummond et al. and Gold et al. The King Health Questionnaire is considered a complete questionnaire for life quality evaluation. DATASUS is not sufficient for the appraisal of used procedures related to the syndrome and its main associated morbid conditions. In view of the syntheses, considering the Government’s point of view, the search for resource allocation efficacy and the perspective of improving patients’ life quality, this research a priori directed its choice of a CEA appraisal of overactive bladder treatment to the following alternatives: electrostimulation and tolterodine LA (4 mg).