Cost-Effectiveness of Minoxidil, Platelet-Rich Plasma (PRP), and Combined Minoxidil and PRP for Androgenetic Alopecia in Men: A Markov/Monte Carlo Analysis
Kevin M. Klifto, DO, PharmD1, Stephen J. Kovach, MD2
1Division of Plastic Surgery, Department of Surgery, University of Missouri School of Medicine, Columbia, MO, USA, 2Division of Plastic Surgery, Department of Surgery, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA, USA
Background: Androgenetic alopecia (AGA) is the most common cause of hair loss in men. We evaluated the cost-effectiveness of minoxidil monotherapy, minoxidil+platelet-rich plasma injections (PRP) combined therapy, and PRP monotherapy for long-term treatment of early onset AGA in men with Hamilton-Norwood stages I-V.
Methods: Men were offered minoxidil 5% topical solution monotherapy, minoxidil 5% topical solution combined with PRP injections (minoxidil+PRP), or PRP injection monotherapy. Minoxidil 5% topical solution was applied to the scalp twice daily. PRP injections were administered at three office visits (0, 4, and 8 weeks), followed by every six months. Markov cohorts modeling with Monte Carlo simulations were performed to analyze the base-case. Simulations began at patient age 25 years and ran over 49 years to age 74. Analyses were conducted from healthcare and societal perspectives. Transition probabilities and quality-of-life values were estimated from the literature and costs were determined from published data and Medicare reimbursement schedules in 2019 United States Dollars (USD). Outcomes were incremental cost-effectiveness ratios (ICER), represented in terms of cost per quality-adjusted life-year (QALY) gained and net monetary benefit (NMB). Willingness-to-pay (WTP) thresholds were set at $50,000 USD and $100,000 USD. One-way and two-way deterministic and probabilistic sensitivity analyses were performed to evaluate data uncertainty over 10,000 different patient simulations.
Results: From a healthcare perspective, compared to minoxidil monotherapy, the ICER for minoxidil+PRP was $51,025 USD/QALY and the ICER for PRP monotherapy was $428,864 USD/QALY. The NMB of minoxidil monotherapy was $1,052,508 USD, minoxidil+PRP was $1,052,221 USD, and PRP monotherapy was $1,041,862 USD at WTP threshold $50,000 USD. PRP was more cost-effective than minoxidil when PRP costs were less than $86.71 USD. Societal perspectives generated similar trends.
Conclusions: Minoxidil 5% topical solution twice-daily monotherapy provided cost-effective treatment for men with AGA Hamilton-Norwood stages I-V at a WTP threshold of $50,000 USD, while combining minoxidil 5% with PRP provided cost-effective treatment at WTP thresholds of $100,000 and $200,000 USD.
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