Finasteride versus dutasteride: A real-world economic evaluation

Objective:The objective of this study was to assess the economic differences between dutasteride and finasteride patients within the first year of initiating treatment. Methods: A retrospective analysis using the PharMetrics Integrated Medical and Pharmaceutical Database (Watertown, Mass) was conducted to assess economic differences in patients who were initiated on dutasteride or finasteride. The database is nationally representative, encompassing administrative claims from more than 45 million patients within 85 managed healthcare plans. Male patients aged 50 years with a diagnosis of benign prostatic hyperplasia who began 5-alpha reductase inhibitor (5ARI) treatment (dutasteride or finasteride) between January 1, 1999, and March 1, 2005, were identified. Patients eligible for study inclusion were matched (1 dutasteride: 3 finasteride) on 4 variables (measured during the 6-month period before their first 5ARI prescription): age, presence of acute urinary retention, total amount of enlarged prostate (EP)-specific charges (+/- $1), and the duration of follow-up (measured in months). EP-specific charges were defined as the total amount charged for EP-specific physician visits, inpatient hospitalizations, outpatient hospital care, emergency department visits, and other ancillary services during the follow-up period for each patient, expressed as average monthly costs. Results: Overall, patients incurred $121.04 in EP-specific charges per month, with inpatient hospitalizations making up 39.1% ($47.29) of the total costs of care. Physician office visits constituted 33.6% ($40.66) of monthly charges. When comparing differences among patients taking the two 5ARIs, patients taking dutasteride incurred $20.50 less per month in EP-specific charges than patients taking finasteride ($105.67 vs $126.17, P =.0007). This reduction in overall medical utilization resulted from a lower amount of inpatient hospitalization charges for dutasteride patients. Conclusion: Patients treated with dutasteride incurred $20.50 less per month in medical costs than patients treated with finasteride. Healthcare plans should consider the incremental differences in medical costs along with the difference in pharmaceutical expenditures when evaluating these two 5ARIs.