MP04-04: COST-UTILITY ANALYSIS OF UPFRONT PHARMACOTHERAPY ... ON FOR PATIENTS WITH BENIGN PROSTATE HYPERPLASIA

COST-UTILITY ANALYSIS OF UPFRONT PHARMACOTHERAPY COMPARED TO AN UPFRONT SURGICAL INTERVENTION FOR PATIENTS WITH BENIGN PROSTATE HYPERPLASIA

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INTRODUCTION

Benign prostate hyperplasia (BPH) may lead to lower urinary tract symptoms. Patients with moderate-to-severe symptoms usually start upfront pharmacotherapy (e.g., alpha-blockers, 5-alpha reductase inhibitors, or combination). Pharmacotherapy doesn’t necessarily cure BPH & patients may require subsequent surgical interventions such as transurethral resection of the prostate (TURP). An alternative to TURP & pharmacotherapy, Greenlight laser photoselective vaporization of the prostate (GL-PVP), has lower costs compared to TURP & faster symptomatic improvement compared to pharmacotherapy. The purpose of this study was to evaluate the cost-utility of upfront pharmacotherapy (i.e., alpha-blockers or 5-ARI or combination) followed by delayed surgical intervention (i.e., TURP, GL-PVP) for those who fail, compared to receiving an upfront surgical intervention.

METHODS

The target population were men with moderate-to-severe symptoms & no contraindications for BPH surgery. Microsimulation was used to model the progression of BPH symptoms, cost projection & quality-adjusted life-years (QALYs). Pharmacotherapy costs were obtained from the Ontario Drug Benefit Formulary. BPH surgeries costs were collected retrospectively. All other outcomes were obtained from the literature. Cost-utility analysis used a Canadian public payer perspective, a life-time time horizon, a discount rate of 1.5% & a willingness-to-pay threshold of $50,000 per QALY. Probabilistic sensitivity analysis (PSA) was performed to estimate parameter uncertainty.

RESULTS

Compared to the upfront pharmacotherapy options, upfront surgical interventions were, on average, more costly & more effective with the incremental cost per QALY gained ranging by drug type from $2,138 to $2,911 for upfront GL-PVP & $5,473 to $6,646 for upfront TURP options. Compared to upfront TURP, upfront GL-PVP was associated with lower costs ($9,468 vs. $11,562) & a marginally lower effectiveness (15.20 vs. 15.24 QALYs) translating to an incremental cost per QALY of $53,417 more gained. PSA indicated that upfront GL-PVP would be cost-effective 47% of the time at a threshold of $50,000/QALY.

CONCLUSION

In general, upfront BPH surgery is cost-effective option relative to pharmacotherapy. Given the lower costs, relative effectiveness & better safety, GL-PVP may be considered as an upfront intervention for certain patients with moderate-to-severe BPH.

Funding: This study was funded with the support of a research grant from Boston Scientific.