OBJECTIVES : To evaluate the cost-effectiveness of dutasteride as the first-line treatment versus finasteride in patients with benign prostatic hyperplasia in China. Besides, the impact of incorporating dutasteride into the Chinese national essential drug list is also assessed given the finasteride is in the list while dutasteride isn’t.

METHODS : A multi-state markov model was constructed with 1 year cycle to estimate the cost-effectiveness by incremental cost per quality of life(QALYs) gained using a 25-year horizon from the patients perspective. Transition probabilities, utilities and the prevalence of adverse events in the model were obtained from the literature review. Mortality and costs were obtained from the government published data. Discount rate for costs and utilities was set as 5%. One-way and probabilistic sensitivity analysis were conducted to evaluate the robustness of the model. In addition, a scenario analysis was conducted to assess the cost-effectiveness of incorporating dutasteride into Chinese national essential drug list, reimbursement related information were obtained from the government published information online.

RESULTS : The ICER of dutasteride versus finasteride was US$10704.93(1 USD=6.5 RMB), compared to threshold of three times China's per capita GDP of US$24369.54 in 2016, Dutasteride is more cost-effectiveness, even if it isn’t in the Chinese national essential drug list. Scenario analysis showed that the ICER is ¥1526.69 per QALY after incorporating dutasteride into the list, which could also save US$1143.51 per person for 25 years. Both one-way and probabilistic sensitivity analysis showed the results are robust.

CONCLUSIONS : Dutasteride is more cost-effectiveness as the first-line treatment versus finasteride in patients with benign prostatic hyperplasia in China whether in the Chinese national essential drug list or not. Moreover, incorporating dutasteride into the list could create more economic benefit to patients.