ECONOMIC MODELING TO ASSESS THE COSTS OF TREATMENT WITH FINASTERIDE, TERAZOSIN, AND TRANSURETHRAL RESECTION OF THE PROSTATE FOR MEN WITH MODERATE TO SEVERE SYMPTOMS OF BENIGN PROSTATIC HYPERPLASIA

Objectives. We developed a decision analytic model to compare the cost s of treatment for an initial 2-year period with finasteride, terazosi n, and transurethral resection of the prostate (TURP) in men with at l east moderate symptoms of benign prostatic hyperplasia (BPH). Outcome measures were BPH treatment costs, duration of symptomatic improvement , and lost productivity days (work or other customary activity). Metho ds. Patterns of health care resource use associated with the treatment of moderate to severe BPH and BPH-related complications were evaluate d by a survey of urologists and validated by a urology consensus panel . BPH safety and efficacy studies in the published literature were use d to provide probabilities of treatment success. Both a national healt h care resource database (Systemetrics) and Medicare data were used to estimate the costs of specific health care services (such as physicia n services and laboratory tests). Results. The probabilities of first- year success (defined as symptomatic improvement) for surgery, finaste ride, and terazosin were 88%, 67%, and 74%, respectively. The most exp ensive intervention was surgery, followed by finasteride and terazosin , at estimated 24-month costs of $6411, $2860, and $2422 for private i nsurance and $3874, $2161, and $1820 for Medicare, respectively. Durat ion of symptom improvement was comparable for the three treatments. Es timates of usual activity days lost (work or other customary activity) were 22, 8, and 8 days for surgery, finasteride, and terazosin, respe ctively. Conclusions, As a primary intervention for patients consideri ng conventional clinical approaches to BPH treatment, pharmacotherapy is expected to be less expensive than TURF over the initial 2 years of therapy.