UK clinical guidelines for treating male patients with moderate to severe LUTS associated with BPH recommend treatment with an alpha-blocker (such as tamsulosin) in cases where conservative management options have not been successful or are not appropriate.
An alpha-blocker plus 5-alpha-reductase inhibitor (such as dutasteride) is recommended for those patients with moderate to severe symptoms and prostate volume >30 mL. The present study evaluates the cost-effectiveness of a new, single-dose combination of tamsulosin and dutasteride (Combodart®) from the perspective of the UK National Health Service. The results show that the combination therapy has a high probability of being cost-effective compared with either monotherapy, and compared with the two therapies taken separately. The probability of the combination therapy being cost-effective at an incremental cost-effectiveness ratio threshold in the range £25 000-£30 000 per quality-adjusted life year is 78-88%.
OBJECTIVE: To estimate the long-term cost-effectiveness of single-dose dutasteride/tamsulosin combination therapy as a first-line treatment for benign prostatic hyperplasia (BPH) from the perspective of the UK National Health Service (NHS).
METHODS: A Markov state transition model was developed to estimate healthcare costs and patient outcomes, measured by quality-adjusted life years (QALYs), for patients aged ≥50 years with diagnosed BPH and moderate to severe symptoms. Costs and outcomes were estimated for two treatment comparators: oral, daily, single-dose combination therapy (dutasteride 0.5 mg + tamsulosin 0.4 mg), and oral daily tamsulosin (0.4 mg) over a period up to 25 years. The efficacy of comparators was taken from results of the Combination of Avodart and Tamsulosin (CombAT) trial.
RESULTS: Cumulative discounted costs per patient were higher with combination therapy than with tamsulosin, but QALYs were also higher. After 25 years, the incremental cost-effectiveness ratio for combination therapy was £12 219, well within the threshold range (£20 000-£30 000 per QALY) typically applied in the NHS. Probabilistic sensitivity analysis showed that the probability of combination therapy being cost-effective given the threshold range is between 78% and 88%.
CONCLUSION: Single-dose combination dutasteride/tamsulosin therapy has a high probability of being cost-effective in comparison to tamsulosin monotherapy in the UK's NHS.
Written by:
Walker A, Doyle S, Posnett J, Hunjan M. Are you the author?
Heron Evidence Development Ltd, Luton, UK.
Reference: BJU Int. 2013 Jan 28. Epub ahead of print.
doi: 10.1111/j.1464-410X.2012.11659.x
PubMed Abstract
PMID: 23356792
