Journal Outcomes Research

Treatments for Benign Prostatic Hyperplasia: An Analysis of Their Clinical and Economic Impact in the United Kingdom and Italy

Abstract

The incidence of benign prostatic hyperplasia (BPH) will escalate as the population ages, placing additional burden on healthcare resources as more men seek treatment. The need for efficacious, cost-effective drug treatments will become increasingly important. The objective of this analysis is to evaluate the clinical and cost-effectiveness of selective a1-adrenoreceptor blockade (doxazosin), 5a-reductase inhibition (finasteride), surgery, and watchful waiting (United Kingdom) or plant extracts (Italy) as initial therapy for BPH in the United Kingdom and Italy. Using a Markov-state transition model, the overall expected outcomes for patients managed with each of these initial treatments were measured in terms of the incremental clinical response achieved relative to baseline treatment and the incremental cost per response year relative to baseline treatment (watchful waiting or plant extracts) over a 5-year period. The response year measure takes into account the rate and degree of response to treatment and the costs include those of consultations, procedures, examinations, medications, surgery, and management of complications. Clinical and economic data were obtained from published literature, including the American Agency for Health Care Policy and Research guidelines for BPH, focus groups, and national and regional governmental agencies. Surgery is the most effective initial treatment option in terms of response-years gained per patient. Among the nonsurgical options, doxazosin treatment was associated with the greatest number of response-years gained. Finasteride gained only slightly more response years than the baseline treatment options. Doxazosin and surgery were broadly similar in cost-effectiveness, yet finasteride was markedly less so. Given the potential for mortality and morbidity with surgery, doxazosin is an important alternative initial treatment option in the management of BPH.