Cost-effectiveness analysis of medical treatment of benign prostatic hyperplasia in the Brazilian public health system

Abstract

ARTICLE INFO _________________________________________________________ ___________________Objective: To perform a cost-effectiveness analysis of medical treatment of benign prostatic hyperplasia (BPH) under Brazilian public health system perspective (Unified Health System -"Sistema Único de Saúde (SUS)"). Material and Methods:A revision of the literature of the medical treatment of BPH using alpha-blockers, 5-alpha-reductase inhibitors and combinations was carried out. A panel of specialists defined the use of public health resources during episodes of acute urinary retention (AUR), the treatment and the evolution of these patients in public hospitals. A model of economic analysis(Markov) predicted the number of episodes of AUR and surgeries (open prostatectomy and transurethral resection of the prostate) related to BPH according to stages of evolution of the disease. Brazilian currency was converted to American dollars according to the theory of Purchasing Power Parity (PPP 2010: US$ 1 = R$ 1.70). Results: The use of finasteride reduced 59.6% of AUR episodes and 57.9% the need of surgery compared to placebo, in a period of six years and taking into account a treatment discontinuity rate of 34%. The mean cost of treatment was R$ 764.11 (US$449.78) and R$ 579.57 (US$ 340.92) per patient in the finasteride and placebo groups, respectively. The incremental cost-effectiveness ratio (ICERs) was R$ 4.130 (US$ 2.429) per episode of AUR avoided and R$ 2.735 (US$ 1.609) per episode of surgery avoided. The comparison of finasteride + doxazosine to placebo showed a reduction of 75.7% of AUR episodes and 66.8% of surgeries in a 4 year time horizon, with a ICERs of R$ 21.191 (US$ 12.918) per AUR episodes avoided and R$ 11.980 (US$ 7.047) per surgery avoided. In the sensitivity analysis the adhesion rate to treatment and the cost of finasteride were the main variables that influenced the results. Conclusions: These findings suggest that the treatment of BPH with finasteride is costeffective compared to placebo in the Brazilian public health system perspective.

Postoperative medical treatment of lower urinary tract symptoms after benign prostatic hyperplasia surgery. Are we underestimating the problem?

“…Surgical intervention may be cheaper than medical treatment over a 5-year period. But 5ARI proved to be more cost-effective than placebo, as they decreased the rate of interventions for AUR [13,14].…”

Short-term clinical and paraclinical evaluation of the treatment of benign prostatic hypertrophy by phytotherapy with Plantago major and Solanum aculeastrum

“…The blood level of creatinine and the cytobacteriological examination (ECBU) completed the primary explorations of BPH [8][9][10][11][12][13][14][15][16] . Medical treatment, even if it avoids complications such as frequent acute urinary retention (AUR) and surgery, still has a high cost [17] . Coulange C also said that from the 8th year it will cost as much as surgical treatment [18] .…”