Economic analysis of finasteride: A model-based approach using data from the Proscar (R) long-term efficacy and safety study

Benign prostatic hyperplasia (BPH) is one of the most common medical condit ions in older men in the United States. BPH is often associated with a redu ction in quality of life and may progress to acute urinary retention (AUR), the inability to pass any urine. Recently, a 4-year placebo-controlled cli nical trial known as the Proscar(R) Long-Term Efficacy and Safety Study (PL ESS) demonstrated that finasteride use reduces the risk of developing AUR b y 57% and the need for BPH-related surgery by 55%. The economic implication s of these findings were investigated using a model-based decision-analytic approach to compare finasteride with both watchful waiting and alpha-block er therapy. The modeling used the longest-term published controlled data co ncerning alpha-blockers, which were for the alpha-blocker terazosin. The ba se case considered a 63-year-old man (the mean age of a PLESS patient) with prostatic enlargement on digital rectal examination and moderate-to-severe symptoms of BPH. The model suggested savings in surgical and AUR costs wit h finasteride versus watchful waiting, with an estimated 25% of total finas teride costs recouped in savings on surgical events avoided in the first ye ar. Over 2 years, the expected cost per patient starting finasteride therap y was $2304, whereas the expected cost per patient starting terazosin was $ 2334. Analyses also explored the variation in economic results by baseline levels of prostate-specific antigen (PSA), a proxy for prostate volume. For patients with PSA levels greater than or equal to 1.4 ng/mL, expected 2-ye ar costs with finasteride and terazosin were $2342 and $2479, respectively. For patients with PSA levels greater than or equal to 3.3 ng/mL, expected 2-year costs with finasteride were $373 less than with terazosin ($2347 vs $2720). Results were robust over a range of model assumptions and cost esti mates. The analyses illustrate that all medical interventions, including wa tchful waiting, have associated costs. Finasteride shows cost offsets compa red with watchful waiting and cost savings compared with terazosin over 2 y ears. Finasteride appears to be more economical in men with higher PSA leve ls.