Edelsberg, J

Oster, G

Pozniak, A

Thompson, D

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PMW1: COSTS OF TREATMENT WITH DOXAZOSIN VERSUS TAMSULOSIN IN MEN WITH BENIGN PROSTATIC HYPERPLASIA 

Abstracts 399
PGI5
COST OF ILLNESS STUDIES MAY LARGELY 
UNDERESTIMATE THE COST OF DISEASES 
WITH UNMET MEDICAL NEED SUCH AS 
IRRITABLE BOWEL SYNDROME (IBS)
Volmer T1, Gehlert I2, Behrens M1
1Health Economics, Glaxo Wellcome GmbH&Co, Hamburg, 
Germany; 2University of Applied Science, Hamburg, Germany
OBJECTIVES: The usefulness of cost of illness studies is
controversial. Nevertheless, they are carried out frequently
and at least raise awareness and draw attention to any eco-
nomic impact a disease may have on a particular health
care system and society. The aim of this analysis was to
quantify the cost of a disease with a high unmet medical
need (Irritable Bowel Syndrome, IBS, ICD9 564.1), using
official German health statistics. Although IBS is reported
to have a prevalence of up to 20%, current evidence sug-
gests, that existing statistics based on the ICD classifica-
tion misrepresent the true economic burden.
METHODS: We used 1997 data from various available
sources of health information and identified direct and in-
direct costs using a “top-down approach” employing se-
lected ICD9 codes (564.1, 564.9), which were commonly
used to document patients with IBS.
RESULTS: The total calculated burden to German society
was 53.5 million Euro (?)
CONCLUSIONS: Medical conditions with unmet need
such as IBS are not well represented in official statistics.
The number of identified patients, the documented re-
source use and the total cost of illness calculated using in-
formation based on ICD9 coding might largely misrepre-
sent the burden of these diseases. Therefore, representative
prospective studies are needed to document such areas of
unmet medical need.
ECONOMIC AND OUTCOMES ISSUES OF 
WOMEN’S AND MEN’S HEALTH DISORDERS
PMW1
COSTS OF TREATMENT WITH DOXAZOSIN 
VERSUS TAMSULOSIN IN MEN WITH BENIGN 
PROSTATIC HYPERPLASIA
Thompson D, Edelsberg J, Pozniak A, Oster G
Policy Analysis, Inc. (PAI), Brookline, MA, USA
OBJECTIVES: To compare the costs of treatment with
doxazosin mesylate versus tamsulosin hydrochloride in
men with benign prostatic hyperplasia (BPH).
METHODS: We used claims data (spanning August 1996
through December 1998) from a large health insurer in the
New England region of the United States to examine dif-
ferences in the utilization and costs of care over a 90-day
period among men with BPH who received doxazosin ver-
sus tamsulosin. Study measures included all BPH-related
prescription drug therapy, office-based physician services,
tests and procedures, and hospital inpatient and outpatient
services.
RESULTS: Subjects who received doxazosin (N  394)
and tamsulosin (N  167) were generally similar in terms
of age, comorbidity status, and pretreatment health-care
costs. Subjects in the doxazosin group had fewer physician
visits during the 90-day period of follow-up (18 fewer per
100 patients; 95% CI: 6, 30) than those in the tamsulosin
group (28 vs 46 per 100). The mean cost of BPH drug
therapy was $11 lower (95% CI: $5, $17) among patients
who received doxazosin ($71 vs $82 for tamsulosin), and
mean costs of follow-up physician visits were $16 lower
(95% CI: $4, $27) ($18 vs $34 respectively). Although
there were no significant differences in the utilization or
costs of diagnostic tests, surgical procedures, or hospital
services, nominal differences in these measures favored
doxazosin. The mean total cost of BPH treatment over 90
days was $173 (95% CI: $92, $253) in the doxazosin
group and $247 (95% CI: $124, $370) in the tamsulosin
group, yielding a difference of $74 (95% CI: $73, $221).
CONCLUSIONS: Men with BPH who received doxazosin
versus tamsulosin had lower costs of BPH-related prescrip-
tion drug therapy and follow-up physician services, and
nominally lower overall costs of BPH treatment.
PMW2
THE VALUATION OF ERECTILE DYSFUNCTION: 
CONVERTING CLINICAL OUTCOMES 
INTO UTILITIES
Stolk EA, Busschbach JJV
Institute for Medical Technology Assessment, Erasmus 
University, Rotterdam, The Netherlands
OBJECTIVES: We converted disease specific outcomes of
treatment for erectile dysfunction (ED) using sildenafil (Vi-
agra) into Quality Adjusted Life Years (QALYs). Due to
size and complexity of most disease specific question-
naires, application of this (recommended) strategy is scarce
and detailed reports about valuation exercises of disease
specific health states are lacking. Such valuation studies
are needed to adapt existing methods to this new strategy.
METHODS: 200 subjects from the general public and
110 ED-patients valued 25 ED-states with Time Trade-Off
to convert the outcomes of a clinical trial into utilities. The
health states reflect different gradations of ED, as categor-
Cost category ICD9 564.1 ICD9 564.9
Number of identified patients 810 000 102 000
1. Ambulatory services [mill. ∈] 22.5 3.1
2. Drugs [mill. ∈] 11.8 6.3
3. Hospital [mill. ∈] 7.0 3.9
4. Other direct [mill. ∈] 0.3 0.1
5. Indirect costs [mill. ∈] 11.9 1.5
6. Total costs [mill. ∈] 53.5 14.9
Mean cost per patient (direct only) [∈] 51.4 13.1


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PMW1: COSTS OF TREATMENT WITH DOXAZOSIN VERSUS TAMSULOSIN IN MEN WITH BENIGN PROSTATIC HYPERPLASIA

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