Long-term cost analysis of treatment options for benign prostatic hyperplasia in Norway

Abstract

Objective. To estimate and compare the costs of dutasteride, finasteride, tamsulosin and transurethral resection of the prostate (TURP) for benign prostatic hyperplasia (BPH) from a Norwegian health service perspective. Material and methods. A Markov model was developed to estimate the clinical progression that a cohort of 1000 men would undergo and the care they would receive over 4- and 15.5-year periods. Transitions between health states [BPH symptoms, improvement in symptoms, acute urinary retention (AUR), TURP, prostate cancer and death] were estimated from the published literature and knowledge of the Norwegian healthcare system. Sensitivity analyses were conducted of indirect costs, discount rates, the costs and probabilities of AUR and TURP and the probability of symptom improvement. Results. The total costs of BPH management for patients initially treated with dutasteride, finasteride, tamsulosin or TURP at 4 years were NOK 13 946 (€1703), NOK 16 111 (€1967), NOK 16 833 (€2054) and NOK 46 309 (€5655), respectively and at 15.5 years NOK 32 137 (€3924), NOK 37 173 (€4539), NOK 40 528 (€4946) and NOK 50 471 (€6164), respectively. One- and multi-way sensitivity analyses did not significantly alter the relative order of the total costs. Conclusions. Given the conservative nature of the model and the robustness of the sensitivity analysis, it is concluded that dutasteride is less costly than finasteride, TURP or tamsulosin at both 4 and 15.5 years. Therefore, considering cost containment restraints in Norway, dutasteride is an appropriate choice of therapy for patients with moderate/severe symptoms and an enlarged prostate (>30 ml).

• Benign prostatic hyperplasia
• cost
• Markov model
• health state
• transition probability