OBJECTIVES: In the treatment of benign prostatic hyperplasia (BPH), patient and physician concerns regarding vasodilatory side effects have led to the increased use of uroselective alpha-blockade as first-line therapy over less expensive, generic, non-uroselective agents. This study evaluated the relative economic impact of two currently available uroselective agents, alfuzosin and tamsulosin. METHODS: A one-year decision analysis was undertaken to project the medical costs associated with treating symptomatic BPH patients with alfuzosin vs. tamsulosin. Key inputs included clinical data (efficacy and adverse events [AEs]), dosing, and routine medical care costs. Clinical data were derived from a comprehensive meta-analysis published as part of recently published BPH treatment guidelines, and resource utilization information was obtained from published sources and two nationwide physician surveys. RESULTS: Both agents had similar efficacy, however, safety profiles differed. Daily average acquisition costs, after adjusting for average wholesale price for tamsulosin ($1.99) and alfuzosin ($1.86) and increased daily average consumption (DACON) (17% of patients required a double dose of tamsulosin), were $1.98 vs. $1.58 per patient per day for tamsulosin and alfuzosin, respectively. This difference based upon price and DACON amounted to $146.00 per patient per year (PPPY) (tamsulosin = $722.70, alfuzosin = $576.70). Costs associated with tamsulosin-related AEs were estimated to be $4.59 PPPY, whereas, alfuzosin-related AEs were $2.25 PPPY ($2.34 PPPY difference). Therefore, in considering the price and DACON differential ($146.00) together with the differential in costs of treating AEs ($2.34), alfuzosin saved $148.34 PPPY, a 20% difference. CONCLUSIONS: Alfuzosin provides cost savings over tamsulosin in the treatment of patients with symptomatic BPH. Savings are realized primarily on the basis of total drug acquisition costs, followed by lower costs associated with treating side effects of therapy. Alfuzosin is a less expensive alternative to tamsulosin as a first-line clinically uroselective drug therapy in the management of men with BPH.