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Keywords:

  • benign prostatic hyperplasia;
  • cost-effectiveness;
  • Markov model;
  • tamsulosin;
  • dutasteride;
  • Combodart;
  • UK

What's known on the subject? and What does the study add?

  • UK clinical guidelines for treating male patients with moderate to severe LUTS associated with BPH recommend treatment with an alpha-blocker (such as tamsulosin) in cases where conservative management options have not been successful or are not appropriate. An alpha-blocker plus 5-alpha-reductase inhibitor (such as dutasteride) is recommended for those patients with moderate to severe symptoms and prostate volume >30 mL.
  • The present study evaluates the cost-effectiveness of a new, single-dose combination of tamsulosin and dutasteride (Combodart®) from the perspective of the UK National Health Service. The results show that the combination therapy has a high probability of being cost-effective compared with either monotherapy, and compared with the two therapies taken separately. The probability of the combination therapy being cost-effective at an incremental cost-effectiveness ratio threshold in the range £25 000–£30 000 per quality-adjusted life year is 78–88%.

Objective

  • To estimate the long-term cost-effectiveness of single-dose dutasteride/tamsulosin combination therapy as a first-line treatment for benign prostatic hyperplasia (BPH) from the perspective of the UK National Health Service (NHS).

Methods

  • A Markov state transition model was developed to estimate healthcare costs and patient outcomes, measured by quality-adjusted life years (QALYs), for patients aged ≥50 years with diagnosed BPH and moderate to severe symptoms.
  • Costs and outcomes were estimated for two treatment comparators: oral, daily, single-dose combination therapy (dutasteride 0.5 mg + tamsulosin 0.4 mg), and oral daily tamsulosin (0.4 mg) over a period up to 25 years.
  • The efficacy of comparators was taken from results of the Combination of Avodart and Tamsulosin (CombAT) trial.

Results

  • Cumulative discounted costs per patient were higher with combination therapy than with tamsulosin, but QALYs were also higher.
  • After 25 years, the incremental cost-effectiveness ratio for combination therapy was £12 219, well within the threshold range (£20 000–£30 000 per QALY) typically applied in the NHS.
  • Probabilistic sensitivity analysis showed that the probability of combination therapy being cost-effective given the threshold range is between 78% and 88%.

Conclusion

  • Single-dose combination dutasteride/tamsulosin therapy has a high probability of being cost-effective in comparison to tamsulosin monotherapy in the UK‘s NHS.