Cost-effectiveness of single-dose tamsulosin and dutasteride combination therapy compared with tamsulosin monotherapy in patients with benign prostatic hyperplasia in the UK
Walker A, Doyle S, Posnett J, Hunjan M. BJU Int. 2013 Jan 28. doi: 10.1111/j.1464-410X.2012.11659.x. [Epub ahead of print]


Heron Evidence Development Ltd, Luton, UK.


WHAT'S KNOWN ON THE SUBJECT? AND WHAT DOES THE STUDY ADD?: UK clinical guidelines for treating male patients with moderate to severe LUTS associated with BPH recommend treatment with an alpha-blocker (such as tamsulosin) in cases where conservative management options have not been successful or are not appropriate. An alpha-blocker plus 5-alpha-reductase inhibitor (such as dutasteride) is recommended for those patients with moderate to severe symptoms and prostate volume >30 mL. The present study evaluates the cost-effectiveness of a new, single-dose combination of tamsulosin and dutasteride (Combodart®) from the perspective of the UK National Health Service. The results show that the combination therapy has a high probability of being cost-effective compared with either monotherapy, and compared with the two therapies taken separately. The probability of the combination therapy being cost-effective at an incremental cost-effectiveness ratio threshold in the range £25 000-£30 000 per quality-adjusted life year is 78-88%.


To estimate the long-term cost-effectiveness of single-dose dutasteride/tamsulosin combination therapy as a first-line treatment for benign prostatic hyperplasia (BPH) from the perspective of the UK National Health Service (NHS).


A Markov state transition model was developed to estimate healthcare costs and patient outcomes, measured by quality-adjusted life years (QALYs), for patients aged ≥50 years with diagnosed BPH and moderate to severe symptoms. Costs and outcomes were estimated for two treatment comparators: oral, daily, single-dose combination therapy (dutasteride 0.5 mg + tamsulosin 0.4 mg), and oral daily tamsulosin (0.4 mg) over a period up to 25 years. The efficacy of comparators was taken from results of the Combination of Avodart and Tamsulosin (CombAT) trial.


Cumulative discounted costs per patient were higher with combination therapy than with tamsulosin, but QALYs were also higher. After 25 years, the incremental cost-effectiveness ratio for combination therapy was £12 219, well within the threshold range (£20 000-£30 000 per QALY) typically applied in the NHS. Probabilistic sensitivity analysis showed that the probability of combination therapy being cost-effective given the threshold range is between 78% and 88%.


Single-dose combination dutasteride/tamsulosin therapy has a high probability of being cost-effective in comparison to tamsulosin monotherapy in the UK's NHS.