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MRCOG PART 2 SBAs and EMQs

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SBA Urogyn

SBA Urogyn Posted by ghada S.

Dear Paul: please clarify this SBA

A The weekly cost of ‘no treatment’ is higher than the weekly cost of anti-cholinergic drugs B The most cost-effective treatment is solifenacin
C The most cost-effective treatment is tolterodine extended release D The least cost-effective drug is oxybutynin immediate release
E The drug with the worse side-effect profile is oxybutynin immediate release    

 

Explanation

 

 

 

                          

Question 2 A 46 year old woman complains of urinary urge incontinence

answer A & E is correct; as I understand from notes that oxybutynin has the worst side effects & is the most common drug to be discontinued???

Posted by PAUL A.
  • The absolute probability of being continent at 4 weeks ranged from 16% for tolterodine (extended release) to 27% for oxybutynin (immediate release)
  • The absolute probability of being continent at 12 weeks ranged from 12% for tolterodine (extended release) to 21% for oxybutynin (immediate release)
  • The absolute probability of discontinuing from treatment at 4 weeks range from 4% for solifenacin and darifenacin to 11% for oxybutynin (immediate release) and propiverine (immediate release)
  • The absolute probability of discontinuing from treatment at 12 weeks range from 15% for solifenacin and darifenacin to 31% for oxybutynin (immediate release) and propiverine (immediate release)
  • The cost per year of OAB drugs ranged from £364 to £578. The difference in effectiveness was very small – a difference less than of 0.01 QALY between the most effective (oxybutynin immediate release) and least effective drug (tolterodine extended release) over a year
  • The weekly cost of oxybutynin (immediate release), and tolterodine (immediate release) were below the cost of no treatment since the latter included £8 per week for incontinence pads.
  • Oxybutynin (immediate release) was the most cost-effective first-line antimuscarinic therapy. All other drugs were more expensive and less effective than oxybutynin immediate release.
  • The probability of a drug being the most cost effective at £20,000 per QALY was highest for oxybutynin (immediate release) and tolterodine (immediate release). All other drugs had no more than a 5% chance of being cost effective at that threshold.

answer A & E is correct; as I understand from notes that oxybutynin has the worst side effects & is the most common drug to be discontinued???

 

The notes do not say that.