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Cost-Effectiveness of Combination Therapy Versus Monotherapy in Benign Prostatic Hyperplasia: A Colombian Experience.
Value Health Reg Issues. 2018 Dec; 17:174-182.VH

Abstract

OBJECTIVES

To estimate the incremental cost-effectiveness ratio of pharmacological treatment for benign prostatic hyperplasia from the payer's perspective.

METHODS

The cost-effectiveness of 5 mg finasteride, 0.5 mg dutasteride, 10 mg alfuzosin, 10 mg terazosin, 0.4 mg tamsulosin, 4 mg doxazosin, and the combination therapy of 5 mg finasteride and 8 mg doxazosin was evaluated using a Markov model over a 30-year period. The costs were estimated using national tariffs and were reported in US dollars. Cost and effectiveness outcomes were discounted at a rate of 5% per year. Men (aged ≥40 years) with moderate to severe lower urinary tract symptoms and uncomplicated benign prostatic hyperplasia were included in the analysis. Outcomes included costs and quality-adjusted life-years. A probabilistic sensitivity analysis was performed on important parameters with Monte-Carlo simulation.

RESULTS

Finasteride alone or in combination with doxazosin dominated all α-blockers. After excluding dominated alternatives, the incremental cost-utility ratio for combination therapy was $377 per quality-adjusted life-year, being a cost-effective alternative using the threshold of $15 000. Model results were robust to changes in costs, utility weights, and probabilities. Acceptability curves consistently demonstrated that the combination therapy was most likely cost-effective.

CONCLUSIONS

The combination of finasteride and doxazosin is cost-effective compared with dutasteride, tamsulosin, terazosin, and alfuzosin in patients with benign prostatic hyperplasia with moderate or severe symptoms who are older than 40 years.

Authors+Show Affiliations

Facultad de Ciencias de la Salud, Centro de Estudios en Protección Social y Economía de la Salud (PROESA), Universidad Icesi, Cali, Colombia. Electronic address: cguevara@icesi.edu.co.Facultad de Ciencias Naturales, Centro de Estudios en Protección Social y Economía de la Salud (PROESA), Universidad Icesi, Cali, Colombia.Facultad de Ciencias de la Salud, University of Valle, Cali, Colombia.Centro de Estudios en Protección Social y Economía de la Salud (PROESA), Universidad Icesi, Cali, Colombia.

Pub Type(s)

Journal Article

Language

eng

PubMed ID

30415110

Citation

Guevara-Cuellar, César Augusto, et al. "Cost-Effectiveness of Combination Therapy Versus Monotherapy in Benign Prostatic Hyperplasia: a Colombian Experience." Value in Health Regional Issues, vol. 17, 2018, pp. 174-182.
Guevara-Cuellar CA, Parody-Rúa E, Garcia-Perdomo HA, et al. Cost-Effectiveness of Combination Therapy Versus Monotherapy in Benign Prostatic Hyperplasia: A Colombian Experience. Value Health Reg Issues. 2018;17:174-182.
Guevara-Cuellar, C. A., Parody-Rúa, E., Garcia-Perdomo, H. A., & Arenas-Duque, A. (2018). Cost-Effectiveness of Combination Therapy Versus Monotherapy in Benign Prostatic Hyperplasia: A Colombian Experience. Value in Health Regional Issues, 17, 174-182. https://doi.org/10.1016/j.vhri.2018.09.004
Guevara-Cuellar CA, et al. Cost-Effectiveness of Combination Therapy Versus Monotherapy in Benign Prostatic Hyperplasia: a Colombian Experience. Value Health Reg Issues. 2018;17:174-182. PubMed PMID: 30415110.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Cost-Effectiveness of Combination Therapy Versus Monotherapy in Benign Prostatic Hyperplasia: A Colombian Experience. AU - Guevara-Cuellar,César Augusto, AU - Parody-Rúa,Elizabeth, AU - Garcia-Perdomo,Herney Andres, AU - Arenas-Duque,Andrea, Y1 - 2018/11/08/ PY - 2017/09/12/received PY - 2018/08/23/revised PY - 2018/09/05/accepted PY - 2018/11/12/pubmed PY - 2019/1/29/medline PY - 2018/11/12/entrez KW - 5-α-reductase inhibitors KW - benign prostatic hyperplasia KW - cost-effectiveness KW - α-adrenergic blockers SP - 174 EP - 182 JF - Value in health regional issues JO - Value Health Reg Issues VL - 17 N2 - OBJECTIVES: To estimate the incremental cost-effectiveness ratio of pharmacological treatment for benign prostatic hyperplasia from the payer's perspective. METHODS: The cost-effectiveness of 5 mg finasteride, 0.5 mg dutasteride, 10 mg alfuzosin, 10 mg terazosin, 0.4 mg tamsulosin, 4 mg doxazosin, and the combination therapy of 5 mg finasteride and 8 mg doxazosin was evaluated using a Markov model over a 30-year period. The costs were estimated using national tariffs and were reported in US dollars. Cost and effectiveness outcomes were discounted at a rate of 5% per year. Men (aged ≥40 years) with moderate to severe lower urinary tract symptoms and uncomplicated benign prostatic hyperplasia were included in the analysis. Outcomes included costs and quality-adjusted life-years. A probabilistic sensitivity analysis was performed on important parameters with Monte-Carlo simulation. RESULTS: Finasteride alone or in combination with doxazosin dominated all α-blockers. After excluding dominated alternatives, the incremental cost-utility ratio for combination therapy was $377 per quality-adjusted life-year, being a cost-effective alternative using the threshold of $15 000. Model results were robust to changes in costs, utility weights, and probabilities. Acceptability curves consistently demonstrated that the combination therapy was most likely cost-effective. CONCLUSIONS: The combination of finasteride and doxazosin is cost-effective compared with dutasteride, tamsulosin, terazosin, and alfuzosin in patients with benign prostatic hyperplasia with moderate or severe symptoms who are older than 40 years. SN - 2212-1102 UR - https://www.unboundmedicine.com/medline/citation/30415110/Cost-Effectiveness_of_Combination_Therapy_Versus_Monotherapy_in_Benign_Prostatic_Hyperplasia:_A_Colombian_Experience L2 - http://www.diseaseinfosearch.org/result/9668 DB - PRIME DP - Unbound Medicine ER -