Long-term cost analysis of treatment options for benign prostatic hyperplasia in Norway.
OBJECTIVE
To estimate and compare the costs of dutasteride, finasteride, tamsulosin and transurethral resection of the prostate (TURP) for benign prostatic hyperplasia (BPH) from a Norwegian health service perspective.


METHODS
A Markov model was developed to estimate the clinical progression that a cohort of 1000 men would undergo and the care they would receive over 4- and 15.5-year periods. Transitions between health states [BPH symptoms, improvement in symptoms, acute urinary retention (AUR), TURP, prostate cancer and death] were estimated from the published literature and knowledge of the Norwegian healthcare system. Sensitivity analyses were conducted of indirect costs, discount rates, the costs and probabilities of AUR and TURP and the probability of symptom improvement.


RESULTS
The total costs of BPH management for patients initially treated with dutasteride, finasteride, tamsulosin or TURP at 4 years were NOK 13,946 (1703 Euro), NOK 16,111 (1967 Euro), NOK 16,833 (2054 Euro) and NOK 46,309 (5655 Euro), respectively and at 15.5 years NOK 32,137 (3924 Euro), NOK 37,173 (4539 Euro), NOK 40,528 (4946 Euro) and NOK 50,471 (6164 Euro), respectively. One- and multi-way sensitivity analyses did not significantly alter the relative order of the total costs. CONCLUSIONS. Given the conservative nature of the model and the robustness of the sensitivity analysis, it is concluded that dutasteride is less costly than finasteride, TURP or tamsulosin at both 4 and 15.5 years. Therefore, considering cost containment restraints in Norway, dutasteride is an appropriate choice of therapy for patients with moderate/severe symptoms and an enlarged prostate (>30 ml).
Johansen
Truls E Bjerklund
TE
Urology Section, Telemark Hospital, Porsgrunn, Norway. tebj@sthf.no
Istad
Jan Anders
JA
D001378:Azasteroids / Q000627:therapeutic use; D003365:Costs and Cost Analysis; D000068538:Dutasteride; D018120:Finasteride / Q000627:therapeutic use; D006801:Humans; D008297:Male; D009664:Norway; D011470:Prostatic Hyperplasia / Q000191:economics* / Q000628:therapy*; D013449:Sulfonamides / Q000627:therapeutic use; D000077409:Tamsulosin; D013997:Time Factors; D020728:Transurethral Resection of Prostate
D001378:Azasteroids; D013449:Sulfonamides; D018120:Finasteride; D000077409:Tamsulosin; D000068538:Dutasteride