Amyn Sayani1, Afisi Ismaila2, Anna Walker3, John Posnett3, Bruno Laroche4, J Curtis Nickel5, Zhen Su6. 1. Medical Affairs, GlaxoSmithKline Canada, Mississauga, ON; 2. Medical Affairs, GlaxoSmithKline Canada, Mississauga, ON; ; Department of Clinical Epidemiology and Biostatistics, McMaster University, Hamilton, ON; 3. Heron Evidence Development Ltd, London, UK; 4. Hôpital Saint-François d'Assise, Centre Hospitalier Universitaire de Québec, QC; 5. Department of Urology, Queen's University, Kingston, ON; 6. Medical Affairs, Sanofi, Cambridge, MA.
Abstract
INTRODUCTION: We estimate the lifetime cost of treatment for moderate/severe symptoms associated with benign prostatic hyperplasia (BPH) in a cohort of Canadian men aged 50 to 59, and we evaluate the costs of 2 daily bioequivalent treatment options: fixed-dose combination (FDC) of dutasteride (0.5 mg) and tamsulosin (0.4 mg), or concomitant administration of dutasteride (0.5 mg) and tamsulosin (0.4 mg) monotherapies. METHODS: The expected lifetime costs were estimated by modelling the incidence of acute urinary retention (AUR), BPH-related surgery and clinical progression over a patient's lifetime (up to 25 years). A model was developed to simulate clinical events over time, based on a discrete Markov process with 6 mutually exclusive health states and annual cycle length. RESULTS: The estimated lifetime budget cost for the cohort of 374 110 men aged 50 to 59 in Canada is between $6.35 billion and $7.60 billion, equivalent to between $16 979 and $20 315 per patient with moderate/severe symptoms associated with BPH. Costs are lower for FDC treatment, with the net difference in lifetime budget impact between the 2 treatment regimens at $1.25 billion. In this analysis, the true costs of BPH in Canada are underestimated for 2 main reasons: (1) to make the analysis tractable, it is restricted to a cohort aged 50 to 59, whereas BPH can affect all men; and (2) a closed cohort approach does not include the costs of new (incident) cases. CONCLUSION: Canadian clinical guidelines recommend the use of the combination of tamsulosin and dutasteride for men with moderate/severe symptoms associated with BPH and enlarged prostate volume. This analysis, using a representational patient group, suggests that the FDC is a more cost-effective treatment option for BPH.
INTRODUCTION: We estimate the lifetime cost of treatment for moderate/severe symptoms associated with benign prostatic hyperplasia (BPH) in a cohort of Canadian men aged 50 to 59, and we evaluate the costs of 2 daily bioequivalent treatment options: fixed-dose combination (FDC) of dutasteride (0.5 mg) and tamsulosin (0.4 mg), or concomitant administration of dutasteride (0.5 mg) and tamsulosin (0.4 mg) monotherapies. METHODS: The expected lifetime costs were estimated by modelling the incidence of acute urinary retention (AUR), BPH-related surgery and clinical progression over a patient's lifetime (up to 25 years). A model was developed to simulate clinical events over time, based on a discrete Markov process with 6 mutually exclusive health states and annual cycle length. RESULTS: The estimated lifetime budget cost for the cohort of 374 110 men aged 50 to 59 in Canada is between $6.35 billion and $7.60 billion, equivalent to between $16 979 and $20 315 per patient with moderate/severe symptoms associated with BPH. Costs are lower for FDC treatment, with the net difference in lifetime budget impact between the 2 treatment regimens at $1.25 billion. In this analysis, the true costs of BPH in Canada are underestimated for 2 main reasons: (1) to make the analysis tractable, it is restricted to a cohort aged 50 to 59, whereas BPH can affect all men; and (2) a closed cohort approach does not include the costs of new (incident) cases. CONCLUSION: Canadian clinical guidelines recommend the use of the combination of tamsulosin and dutasteride for men with moderate/severe symptoms associated with BPH and enlarged prostate volume. This analysis, using a representational patient group, suggests that the FDC is a more cost-effective treatment option for BPH.
Authors: J J de la Rosette; G Alivizatos; S Madersbacher; M Perachino; D Thomas; F Desgrandchamps; M de Wildt Journal: Eur Urol Date: 2001-09 Impact factor: 20.096
Authors: J Curtis Nickel; Carlos E Méndez-Probst; Thomas F Whelan; Ryan F Paterson; Hassan Razvi Journal: Can Urol Assoc J Date: 2010-10 Impact factor: 1.862
Authors: W M Garraway; E B Russell; R J Lee; G N Collins; G B McKelvie; M Hehir; A C Rogers; R J Simpson Journal: Br J Gen Pract Date: 1993-08 Impact factor: 5.386
Authors: K M C Verhamme; J P Dieleman; G S Bleumink; J van der Lei; M C J M Sturkenboom; W Artibani; B Begaud; R Berges; A Borkowski; C R Chappel; A Costello; P Dobronski; R D T Farmer; F Jiménez Cruz; U Jonas; K MacRae; L Pientka; F F H Rutten; C P van Schayck; M J Speakman; M C Sturkenboom; P Tiellac; A Tubaro; G Vallencien; R Vela Navarrete Journal: Eur Urol Date: 2002-10 Impact factor: 20.096