title: Cost-effectiveness analysis of medical treatment of benign prostatic hyperplasia in the Brazilian public health system.
abstract: OBJECTIVE
  To perform a cost-effectiveness analysis of medical treatment of benign prostatic hyperplasia (BPH) under Brazilian public health system perspective (Unified Health System--"Sistema Unico de Saude (SUS)").
  
  
  METHODS
  A revision of the literature of the medical treatment of BPH using alpha-blockers, 5-alpha-reductase inhibitors and combinations was carried out. A panel of specialists defined the use of public health resources during episodes of acute urinary retention (AUR), the treatment and the evolution of these patients in public hospitals. A model of economic analysis (Markov) predicted the number of episodes of AUR and surgeries (open prostatectomy and transurethral resection of the prostate) related to BPH according to stages of evolution of the disease. Brazilian currency was converted to American dollars according to the theory of Purchasing Power Parity (PPP 2010: US$ 1 = R$ 1.70).
  
  
  RESULTS
  The use of finasteride reduced 59.6% of AUR episodes and 57.9% the need of surgery compared to placebo, in a period of six years and taking into account a treatment discontinuity rate of 34%. The mean cost of treatment was R$ 764.11 (US$ 449.78) and R$ 579.57 (US$ 340.92) per patient in the finasteride and placebo groups, respectively. The incremental cost-effectiveness ratio (ICERs) was R$ 4.130 (US$ 2.429) per episode of AUR avoided and R$ 2.735 (US$ 1.609) per episode of surgery avoided. The comparison of finasteride + doxazosine to placebo showed a reduction of 75.7% of AUR episodes and 66.8% of surgeries in a 4 year time horizon, with a ICERs of R$ 21.191 (US$ 12.918) per AUR episodes avoided and R$ 11.980 (US$ 7.047) per surgery avoided. In the sensitivity analysis the adhesion rate to treatment and the cost of finasteride were the main variables that influenced the results.
  
  
  CONCLUSIONS
  These findings suggest that the treatment of BPH with finasteride is cost-effective compared to placebo in the Brazilian public health system perspective.
authors.affiliation: State University of Rio de Janeiro, Rio de Janeiro, Brazil.
authors.forename: Luciana Ribeiro
authors.initials: LR
authors.lastname: Bahia
authors.forename: Denizar Vianna
authors.initials: DV
authors.lastname: Araujo
authors.forename: Camila
authors.initials: C
authors.lastname: Pepe
authors.forename: Michelle
authors.initials: M
authors.lastname: Trindade
authors.forename: Caroline Mendonça
authors.initials: CM
authors.lastname: Camargo
authors.forename: Valter
authors.initials: V
authors.lastname: Javaroni
mesh_terms: D058891:5-alpha Reductase Inhibitors / Q000191:economics / Q000627:therapeutic use; D058668:Adrenergic alpha-1 Receptor Antagonists / Q000191:economics / Q000627:therapeutic use; D000971:Antineoplastic Combined Chemotherapy Protocols / Q000191:economics / Q000627:therapeutic use; D001938:Brazil; D003362:Cost-Benefit Analysis; D017292:Doxazosin / Q000191:economics / Q000627:therapeutic use; D018120:Finasteride / Q000191:economics / Q000627:therapeutic use; D017048:Health Care Costs / Q000706:statistics & numerical data*; D006801:Humans; D008297:Male; D009313:National Health Programs / Q000191:economics*; D011470:Prostatic Hyperplasia / Q000191:economics / Q000628:therapy*; D013997:Time Factors; D016896:Treatment Outcome
chemical_list: D058891:5-alpha Reductase Inhibitors; D058668:Adrenergic alpha-1 Receptor Antagonists; D018120:Finasteride; D017292:Doxazosin