A prospective analysis of the cost-effectiveness of alfuzosin, tamsulosin and silodosin for 12 weeks in benign prostatic hyperplasia
Keywords:ACER, Alfuzosin, Benign prostatic hyperplasia, Cost-effectiveness, ICER, Silodosin, Tamsulosin
Background: Benign prostatic hyperplasia (BPH) is usually seen in men above 45 years. α-blockers (alfuzosin, tamsulosin and silodosin) form the mainstay of pharmacological management of symptomatic BPH and may differ in their efficacy, tolerability and treatment costs. The present study compares them prospectively to evaluate the most cost-effective α-blocker in the management of BPH.
Methods: Ninety subjects diagnosed with symptomatic BPH were randomised to receive alfuzosin, tamsulosin or silodosin and were followed up at 2, 4, 8 and 12 weeks after treatment initiation. Effectiveness was assessed by rate of treatment success and number of symptom free days (SFDs). Treatment related direct medical, direct non-medical and indirect costs were analysed both from patient and third-party perspective. Cost-effectiveness was assessed using average cost-effectiveness ratio (ACER) and incremental cost-effectiveness ratio (ICER).
Results: With rate of treatment success as the outcome measure, alfuzosin had the least ACER, followed by tamsulosin and silodosin. With number of SFDs as the outcome measure, alfuzosin had the least ACER followed by silodosin and tamsulosin. An additional INR 3982 and INR 30 were required per extra success and extra SFD respectively with alfuzosin when compared to tamsulosin. Alfuzosin dominated silodosin as a more cost-effective option in achieving treatment success. However, an additional INR 231 was required to achieve an extra SFD with silodosin.
Conclusions: Compared with tamsulosin and silodosin, alfuzosin seems to be the most economical α-blocker in the management of BPH, both from patient and third-party perspective.Short duration of study of 12 weeks was a limitation in the present prospective study.
Rossi M, Roumeguère T. Silodosin in the treatment of benign prostatic hyperplasia. Drug Des Devel Ther. 2010;4:291-7.
Yoshida M, Kudoh J, Homma Y, Kawabe K. Safety and efficacy of silodosin for the treatment of benign prostatic hyperplasia. ClinInterv Aging. 2011;6:161-72.
Di Santostefano RL, Biddle AK, Lavelle JP. The long-term cost effectiveness of treatments for benign prostatic hyperplasia. Pharmacoeconomics. 2006;24(2):171-91.
Walker A, Doyle S, Posnett J, Hunjan M. Cost-effectiveness of single-dose tamsulosin and dutasteride combination therapy compared with tamsulosin monotherapy in patients with benign prostatic hyperplasia in the UK. BJU Int. 2013;112(5):638-46.
Ismaila A, Walker A, Sayani A, Laroche B, Nickel JC, Posnett J, et al. Cost-effectiveness of dutasteride-tamsulosin combination therapy for the treatment of symptomatic benign prostatic hyperplasia: A Canadian model based on the Comb AT trial. Can UrolAssoc J. 2013;7(5-6):E393-401.
Takayama T, Arakawa I, Kakihara H, Tachibana K, Ozono S. Pharmacoeconomic evaluation of combination therapy with dutasteride and α1 blocker for treatment of benign prostatic hyperplasia in Japan. Hinyokika Kiyo. 2012;58(2):61-9.
Tennvall RG, Hjelmgren J, Malmberg L. Under what conditions is feedback microwave thermotherapy (ProstaLund Feedback Treatment) cost-effective in comparison with alpha-blockade in the treatment of benign prostatic hyperplasia and lower urinary tract symptoms? Scand J UrolNephrol. 2006;40(6):495-505.
Nickel JC. BPH: costs and treatment outcomes. Am J Manag Care. 2006;12(5):S141-8.
Chirikos TN, Sanford E. Cost consequences of surveillance, medical management or surgery for benign prostatic hyperplasia. J Urol. 1996;155(4):1311-6.
Manjunatha R, Pundarikaksha HP, Madhusudhana H R, Amarkumar J, Hanumantharaju BK. A randomized, comparative, open-label study of efficacy and tolerability of alfuzosin, tamsulosin and silodosin in benign prostatic hyperplasia. Indian J Pharmacol. 2016;48:134-40.
Mc Nicholas TA, Kirby RS, Lepor H. Evaluation and nonsurgical management of benign prostatic hyperplasia. In: Wein AJ, kavoussi LR, Partin AW, Novick AC, Peters CA, editors. Campbell-Walsh urology. 10th edition. Philadelphia, PA: Saunders; 2012:2611-2654.
Tanguay S, Awde M, Brock G, Casey R, Kozak J, Lee J, et al. Diagnosis and management of benign prostatic hyperplasia in primary care. Can Urol Assoc J. 2009;3(2):S92-S100.
Walley T, Chapter 9. Pharmacoeconomics and Economic Evaluation of Drug Therapies. [Updated 2012 July 13]. Available at: http://www.iuphar.org/pdf/hum_67.pdf. Accessed on March 1, 2013
Reddy VK, Girish K, Lakshmi P, Vijendra R, Kumar A, Harsha R. Cost-effectiveness analysis of baclofen and chlordiazepoxide in uncomplicated alcohol-withdrawal syndrome. Indian J Pharmacol 2014;46:372-7.
Department of Labour Karanataka [homepage on the internet]. Bengaluru: Department of labour; Notifications on minimum wages; [updated 2014 Aug 4] Available from: http://labour.kar.nic.in/labour/notification.htm. Accessed on September 20, 2014.
Ohsfeldt RL, Kreder KJ, Klein RW, Chrischilles EA. Cost-effectiveness of tamsulosin, doxazosin, and terazosin in the treatment of benign prostatic hyperplasia. J Manag Care Pharm. 2004;10:412-22.
Yu HJ, Lin AT, Yang SS, Tsui KH, Wu HC, Cheng CL, et al. Non-inferiority of silodosin to tamsulosin in treating patients with lower urinary tract symptoms (LUTS) associated with benign prostatic hyperplasia (BPH). BJU Int. 2011;108:1843-8.
The Uppsala monitoring centre [homepage on the internet]. Uppsala, Sweden: Pharmacovigilance; [updated 2013 Jan 30] Available from: http://who-umc.org/Graphics/26649.pdf. Accessed on March 1, 2013.