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A prospective analysis of the cost-effectiveness of alfuzosin, tamsulosin and silodosin for 12 weeks in benign prostatic hyperplasia

Manjunatha R., Pundarikaksha H. P., Madhusudhana H. R..

Abstract
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.

Key words: ACER, Alfuzosin, Benign prostatic hyperplasia, Cost-effectiveness, ICER, Silodosin, Tamsulosin


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