title: A cost effective analysis of fixed-dose combination of dutasteride and tamsulosin compared with dutasteride monotherapy for benign prostatic hyperplasia in Nigeria: a middle income perspective; using an interactive Markov model.
abstract: The number of Nigerian men presenting with benign prostatic hyperplasia is on the rise because of increase awareness about the ailment. With the renewed effort by the national health insurance scheme to cover the informal sector, it becomes imperative to determine the cost implication for managing Benign Prostatic Hyperplasia (BPH) and the cost effective drug combination to be adopted. The objective of this study is to estimate cost effective analysis (CEA) of fixed -dose combination of dutasteride and tamsulosin compared with dutasteride monotherapy from the health service provider perspective design.
  
  
  
  An interactive Markov's model was used to generate incremental cost per QALY and incremental cost per life years gained. 2.9 million Men who were 50 years of age were fed into the model. The outcome measures included: costs of drug treatment, consultation, acute urinary retention (AUR), transurethral resection of prostate (TURP), hospitalisation post TURP, and quality adjusted life years (QALYs), incremental cost per life years gained, and incremental cost per QALY gained.
  
  
  
  Fixed-dose combination of dutasteride and tamsulosin (FDCT) produced an Incremental cost-effectiveness ratios of US$1481.92 per Quality adjusted for life-years saved.
  
  
  
  Universal FDCT provision for Nigeria has major economic implications. This study in the context of its limitations has demonstrated the cost effectiveness of FDCT for the long term treatment of patients with moderate to severe BPH from the perspective of a developing country. Currently, there are few studies available to give economic data evidence to policy makers in Nigeria which is applicable to developing countries with similar economies. As such, the findings in this study will be relevant to policy makers in these countries.
authors.affiliation: Department of Surgery, Faculty of medicine, College of Medicine, University of Nigeria Enugu campus, Enugu, Nigeria. emeka.udeh@unn.edu.ng.
authors.forename: Emeka I
authors.initials: EI
authors.lastname: Udeh
authors.affiliation: Division of Urology, Department of Surgery, Jos University Teaching Hospital, Jos, Nigeria.
authors.forename: Chimaobi G
authors.initials: CG
authors.lastname: Ofoha
authors.affiliation: Department of Community Medicine, Bowen University/Bowen University Teaching Hospital, Iwo/Ogbomoso, Nigeria.
authors.forename: David A
authors.initials: DA
authors.lastname: Adewole
authors.affiliation: Department of Surgery, University of Nigeria Teaching Hospital Ituku-Ozalla Enugu, Enugu, Nigeria.
authors.forename: Ikenna I
authors.initials: II
authors.lastname: Nnabugwu
mesh_terms: D003362:Cost-Benefit Analysis / Q000379:methods*; D004338:Drug Combinations; D000068538:Dutasteride / Q000008:administration & dosage* / Q000191:economics / Q000627:therapeutic use; D017048:Health Care Costs / Q000706:statistics & numerical data*; D006760:Hospitalization / Q000706:statistics & numerical data; D006801:Humans; D008297:Male; D008390:Markov Chains; D008875:Middle Aged; D009549:Nigeria; D011470:Prostatic Hyperplasia / Q000188:drug therapy* / Q000191:economics; D019057:Quality-Adjusted Life Years; D012959:Socioeconomic Factors; D013449:Sulfonamides / Q000008:administration & dosage* / Q000191:economics / Q000627:therapeutic use; D000077409:Tamsulosin; D016896:Treatment Outcome; D016055:Urinary Retention / Q000453:epidemiology
chemical_list: D004338:Drug Combinations; D013449:Sulfonamides; D000077409:Tamsulosin; D000068538:Dutasteride
keywords: Benign prostatic hyperplasia; Cost effectiveness analysis; Dutasteride monotherapy; Fixed dose combination of dutasteride- tamsulosin; Nigerian men