Cost-effectiveness of single-dose tamsulosin and dutasteride combination therapy compared with tamsulosin monotherapy in patients with benign prostatic hyperplasia in the UK.
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%.


CONCLUSIONS
Single-dose combination dutasteride/tamsulosin therapy has a high probability of being cost-effective in comparison to tamsulosin monotherapy in the UK's NHS.
Heron Evidence Development Ltd, Luton, UK.
Anna
A
Walker
Scott
S
Doyle
John
J
Posnett
Manjit
M
Hunjan
D058891:5-alpha Reductase Inhibitors / Q000191:economics / Q000627:therapeutic use*; D058668:Adrenergic alpha-1 Receptor Antagonists / Q000191:economics / Q000627:therapeutic use*; D001378:Azasteroids / Q000191:economics / Q000627:therapeutic use*; D003362:Cost-Benefit Analysis; D018450:Disease Progression; D004334:Drug Administration Schedule; D016527:Drug Costs; D004359:Drug Therapy, Combination; D000068538:Dutasteride; D006801:Humans; D008297:Male; D008390:Markov Chains; D008875:Middle Aged; D017410:Practice Guidelines as Topic; D011470:Prostatic Hyperplasia / Q000188:drug therapy* / Q000191:economics* / Q000473:pathology; D019057:Quality-Adjusted Life Years; D013222:State Medicine / Q000191:economics; D013449:Sulfonamides / Q000191:economics / Q000627:therapeutic use*; D000077409:Tamsulosin; D016896:Treatment Outcome; D006113:United Kingdom / Q000453:epidemiology
D058891:5-alpha Reductase Inhibitors; D058668:Adrenergic alpha-1 Receptor Antagonists; D001378:Azasteroids; D013449:Sulfonamides; D000077409:Tamsulosin; D000068538:Dutasteride
Combodart; Markov model; UK; benign prostatic hyperplasia; cost-effectiveness; dutasteride; tamsulosin