AN ECONOMIC-EVALUATION OF FINASTERIDE FOR TREATMENT OF BENIGN PROSTATIC HYPERPLASIA

This evaluation was conducted at the request of a Canadian provincial government considering finasteride for formulary inclusion. The compar ator therapies, in accordance with Canadian pharmacoeconomic guideline s, were the most prevalent treatment [transurethral resection of the p rostate (TURP)] and the lowest cost treatment (watchful waiting). All costs were measured in 1994 Canadian dollars ($Can), and both costs an d outcomes were discounted at 5% per annum. Cost-effectiveness and cos t-utility ratios were calculated, and were found to be dependent on in itial symptom severity and the anticipated duration of treatment with finasteride. The drug was shown to be the dominant alternative compare d with both TURF and watchful waiting for patients with moderate sympt oms, when the duration of drug therapy is 3 years or less. However, fi nasteride is a weak alternative for patients with severe symptoms who are treated for 4 years or more. For other groups of patients (i.e. mo derate symptoms and on finasteride for 4 years or more; severe symptom s and on treatment for 3 years or less), the drug can improve health-r elated quality of life, but at a cost of between $Can3000 and $Can97 0 00 per incremental quality-adjusted life year(1994 dollars). Our study also indicated that it would cost between $Can2.7 million and $Can5.6 million, depending on the severity mix of the patients, to treat a co hort of 10 000 men aged 60 years or older with finasteride.