OBJECTIVES:

European guidelines recommend combination therapy with an alpha‑blocker plus antimuscarinic in men with LUTS/BPH and residual storage symptoms after monotherapy treatment with either drug. Using predominantly real‑world evidence, this study estimated the cost of treating men with LUTS/BPH with alpha-blocker plus antimuscarinic therapy given as a FDC tablet or as CCT in the Netherlands from a societal perspective.

METHODS:

A Markov model with monthly cycles and 1-year time horizon was developed. Men with LUTS/BPH (n=100) receive daily treatment with FDC solifenacin 6mg plus TOCAS 0.4mg or CCT alpha‑blocker plus antimuscarinic (fesoterodine 4mg, oxybutynin immediate-release [IR] 15mg, solifenacin 5mg, tolterodine extended-release [ER] 4mg, tolterodine IR 4 mg, darifenacin 7.5mg). At the end of each cycle, men persist on treatment, discontinue treatment, switch combination therapy or undergo surgery. Model inputs, derived from the literature and real-world evidence, included 1-year treatment persistence and switching, mortality, direct medical costs and lost productivity. A one-way sensitivity analysis determined the influence of key inputs on the results.

RESULTS:

A higher proportion of the cohort persisted on treatment with FDC solifenacin plus TOCAS versus the comparators (52.1% vs. 25.8–32.6%). FDC solifenacin plus TOCAS was associated with reduced resource use, including fewer surgeries (n=20.8 vs. 29.0–31.8) and work hours lost (n=1387 vs. 2073–2348), and higher drug acquisition costs (€31,110.13 vs. €4,935.58–25,984.60) versus the comparators. Overall, total estimated annual costs were €117,603.48 (€3.22/patient/day) for FDC solifenacin plus TOCAS versus €122,723.28–153,854.48 (€3.36–4.21/patient/day) for the comparators. Key drivers of the results were 1-year persistence and switching treatment.

CONCLUSIONS:

In the Netherlands, FDC solifenacin plus TOCAS is associated with lower resource use, fewer work hours lost, and lower total costs. These results may suggest a clinical and economic benefit of FDC solifenacin plus TOCAS compared with concomitant alpha‑blocker plus antimuscarinic therapies in men with LUTS/BPH.