Cost-Effectiveness of Combination Therapy Versus Monotherapy in Benign Prostatic Hyperplasia: A Colombian Experience

• Published in: Value in health regional issues Vol. 17; pp. 174 - 182
• Main Authors: Guevara-Cuellar, César Augusto, Parody-Rúa, Elizabeth, Garcia-Perdomo, Herney Andres, Arenas-Duque, Andrea
• Format: Journal Article
• Language: English
• Published: United States Elsevier Inc 01.12.2018
• Subjects: 5-α-reductase inhibitors; benign prostatic hyperplasia; cost-effectiveness; α-adrenergic blockers; α-adrenergic blockers; cost-effectiveness; 5-α-reductase inhibitors; benign prostatic hyperplasia
• ISSN: 2212-1099; 2212-1102
• DOI: 10.1016/j.vhri.2018.09.004

•A significant number of patients with benign prostatic hyperplasia are treated with pharmacological alternatives chronically. This treatment supposes an important medical cost in developing countries.•This study showed that finasteride alone and combined with doxazosin are efficient alternatives in treating patients with benign prostatic hyperplasia who require medical treatment in the Colombian health system.•The combination therapy is the most efficient pharmacological alternative for benign prostatic hyperplasia because it reduces the number of acute urinary retention episodes, the severity of symptoms, and the probability of surgery. To estimate the incremental cost-effectiveness ratio of pharmacological treatment for benign prostatic hyperplasia from the payer's perspective. The cost-effectiveness of 5 mg finasteride, 0.5 mg dutasteride, 10 mg alfuzosin, 10 mg terazosin, 0.4 mg tamsulosin, 4 mg doxazosin, and the combination therapy of 5 mg finasteride and 8 mg doxazosin was evaluated using a Markov model over a 30-year period. The costs were estimated using national tariffs and were reported in US dollars. Cost and effectiveness outcomes were discounted at a rate of 5% per year. Men (aged ≥40 years) with moderate to severe lower urinary tract symptoms and uncomplicated benign prostatic hyperplasia were included in the analysis. Outcomes included costs and quality-adjusted life-years. A probabilistic sensitivity analysis was performed on important parameters with Monte-Carlo simulation. Finasteride alone or in combination with doxazosin dominated all α-blockers. After excluding dominated alternatives, the incremental cost–utility ratio for combination therapy was $377 per quality-adjusted life-year, being a cost-effective alternative using the threshold of $15 000. Model results were robust to changes in costs, utility weights, and probabilities. Acceptability curves consistently demonstrated that the combination therapy was most likely cost-effective. The combination of finasteride and doxazosin is cost-effective compared with dutasteride, tamsulosin, terazosin, and alfuzosin in patients with benign prostatic hyperplasia with moderate or severe symptoms who are older than 40 years.