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PharmacoEconomics
Erschienen in: PharmacoEconomics 2/2006

01.02.2006 | Original Research Article

The Long-Term Cost Effectiveness of Treatments for Benign Prostatic Hyperplasia

verfasst von: Rachael L. DiSantostefano, Andrea K. Biddle, John P. Lavelle

Erschienen in: PharmacoEconomics | Ausgabe 2/2006

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Abstract

Introduction

Excellent treatment outcomes with long-term durability and few adverse effects are expectations of treatments for chronic conditions. The long-term cost effectiveness of newer treatments for benign prostatic hyperplasia (BPH), including high-energy transurethral microwave thermotherapy (TUMT) and combination pharmaceutical therapy, has not been sufficiently studied against existing alternatives. The objective of this study was to estimate the incremental cost effectiveness of BPH treatment alternatives.

Methods

We employed a Markov model over a 20-year time horizon and the payer’s perspective to evaluate the cost effectiveness of watchful waiting (WW), pharmaceuticals (α-adrenoceptor antagonists [α-blockers], 5-α-reductase inhibitors [5-ARIs], combination therapy), TUMT and transurethral resection of the prostate (TURP) in treating BPH. Markov states included improvement in symptoms, no improvement in symptoms, adverse effects and death.
We used data from the published literature for outcomes, including systematic reviews whenever possible. Costs were estimated using a managed-care claims database and Medicare fee schedules, and were reported in $US, 2004 values. Costs and effectiveness outcomes were discounted at a rate of 3% per year. Men (aged ≥45 years) with moderate to severe lower urinary tract symptoms and uncomplicated BPH were included in the analysis, and results were stratified by age and BPH symptom levels.
Outcomes included costs, QALYs, incremental cost-utility ratios and cost-effectiveness acceptability curves. Sensitivity analysis was performed on important parameters, with an emphasis on probabilistic sensitivity analysis.

Results

α-Blockers and TUMT were cost effective for treating moderate symptoms using the threshold of $US50 000 per QALY. For example, at 65 years of age, the cost per QALY was $US16 018 for α-blockers compared with WW and $US30 204 for TUMT versus α-blockers. TURP was the most cost-effective treatment for severe symptoms ($US5824 per QALY) versus WW. Model results were robust to changes in costs and sensitive to the assumed probabilities, utility weights, extent of improvement and life expectancy. Nevertheless, acceptability curves consistently demonstrated the same alternatives as most likely to be cost effective.

Conclusions

Our model suggests that α-blockers and TURP appear to be the most cost-effective alternatives, from a US payer perspective, for BPH patients with moderate and severe symptoms, respectively. TUMT was promising for patients with moderate symptoms and the oldest patients with severe symptoms, but otherwise was dominated. Value of information analysis could be used to determine the net benefit of additional research.
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Metadaten
Titel
The Long-Term Cost Effectiveness of Treatments for Benign Prostatic Hyperplasia
verfasst von
Rachael L. DiSantostefano
Andrea K. Biddle
John P. Lavelle
Publikationsdatum
01.02.2006
Verlag
Springer International Publishing
Erschienen in
PharmacoEconomics / Ausgabe 2/2006
Print ISSN: 1170-7690
Elektronische ISSN: 1179-2027
DOI
https://doi.org/10.2165/00019053-200624020-00006

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