Cost-effectiveness of dutasteride-tamsulosin combination therapy for the treatment of symptomatic benign prostatic hyperplasia: A Canadian model based on the CombAT trial
Afisi Ismaila1,2, Anna N. Walker3, Amyn Sayani2, B Laroche4, J. Curtis Nickel5, John Posnett3, Zhen Su2
1Department of Clinical Epidemiology and Biostatistics, McMaster University, Hamilton ON
2Medical Affairs, GlaxoSmithKline Canada, Mississauga, ON
3Heron Evidence Development, Stopsley, Luton, United Kingdom
4Hôpital Saint-François d'Assise, Centre Hospitalier Universitaire de Québec, Québec, QC
5Department of Urology, Queen's University, Kingston, ON
Tóm tắt
Introduction: Benign prostatic hyperplasia (BPH) is common in men 50 years old and older. The main treatment options are alpha-blockers (such as tamsulosin), which reduce symptoms, and 5-alpha reductase inhibitors (such as dutasteride), which reduce symptoms and slow disease progression. Clinical studies have demonstrated that dutasteride-tamsulosin combination therapy is more effective than either monotherapy to treat symptomatic BPH. We studied the cost-effectiveness in Canada of the dutasteride (0.5 mg/day) and tamsulosin (0.4 mg/day) combination compared with tamsulosin or dutasteride monotherapy.Methods: A Markov model was developed which follows a cohort of male BPH patients ≥50 with moderate to severe lower urinary tract symptoms (LUTS). The model estimates costs to the Canadian health care system and outcomes (in terms of quality adjusted life years [QALYs]) at 10 years and over a patient’s lifetime. The dutasteride-tamsulosin combination was compared to each of tamsulosin monotherapy and dutasteride monotherapy.Results: Compared with tamsulosin, the combination was more costly and produced better patient outcomes. Over a lifetime, the incremental cost-effectiveness ratio was CAN$25 437 per QALY gained. At a willingness to pay CAN$50 000 per QALY, the probability of combination therapy being cost-effective was 99.6%. Compared with dutasteride, the combination therapy was the dominant option from year 2, offering improved patient outcomes at lower cost. The probability that combination therapy is more cost-effective than dutasteride was 99.8%.Conclusion: Combination therapy offers important clinical benefits for patients with symptomatic BPH, and there is a high probability that it is cost-effective in the Canadian health care system relative to either monotherapy.
