Minoxidil, Platelet-Rich Plasma (PRP), or Combined Minoxidil and PRP for Androgenetic Alopecia in Men: A Cost-Effectiveness Markov Decision Analysis of Prospective Studies.

Kevin M Klifto,Sammy Othman,Stephen J Kovach

doi:10.7759/cureus.20839

Abstract

BackgroundAndrogenetic alopecia (AGA) is the most common cause of hair loss in men. In this study, we evaluated the cost-effectiveness of minoxidil monotherapy, minoxidil and platelet-rich plasma (PRP) combined therapy, and PRP monotherapy for the long-term treatment of early-onset AGA Hamilton-Norwood stages I-V in men.MethodologyMarkov modeling was performed to analyze the base-case parameters from 18 level I/II studies. The model base-case assumes a healthy 25-year-old man presenting to a dermatologist or plastic surgeon’s office as a new patient for the evaluation and treatment of AGA Hamilton-Norwood stages I-V (non-severe AGA in men). Simulations began at an age of 25 years and ran over 35 years. Analyses were conducted from healthcare and societal perspectives. Outcomes included incremental cost-effectiveness ratios (ICER) and net monetary benefits (NMB). Willingness-to-pay (WTP) thresholds were set at $50,000 and $100,000. Deterministic and probabilistic sensitivity analyses were performed to evaluate uncertainty over 10,000 simulations.ResultsFrom a healthcare perspective, compared to minoxidil monotherapy, the ICER for minoxidil+PRP was $52,036/quality-adjusted-life-year (QALY) and the ICER for PRP monotherapy was $439,303/QALY. The NMB of minoxidil monotherapy was $914,887, minoxidil+PRP was $914,350, and PRP monotherapy was $904,572 at a WTP threshold of $50,000. When the WTP threshold was increased to $100,000, the NMB of minoxidil+PRP was $1,843,908, minoxidil monotherapy was $1,831,237, and PRP monotherapy was $1,822,246. Societal trends were similar.ConclusionsMinoxidil 5% topical twice-daily monotherapy provided cost-effective treatment for men with AGA Hamilton-Norwood stages I-V at a WTP threshold of $50,000, whereas combining minoxidil 5% with PRP provided cost-effective treatment at a WTP threshold of $100,000.Level of evidence: Level II.

Highlights

Androgenetic alopecia (AGA) is the most common cause of hair loss in men, affecting 30-50% of men by the age of 50 years [1]
Minoxidil 5% topical twice-daily monotherapy provided cost-effective treatment for men with AGA Hamilton-Norwood stages I-V at a WTP threshold of $50,000, whereas combining minoxidil 5% with platelet-rich plasma (PRP) provided cost-effective treatment at a WTP threshold of $100,000
The morbidity of AGA is primarily psychological, hair loss may increase the risk of scalp skin cancers [1,2]

Summary

Introduction

Androgenetic alopecia (AGA) is the most common cause of hair loss in men, affecting 30-50% of men by the age of 50 years [1]. AGA in men or male pattern baldness occurs in a highly reproducible pattern, preferentially affecting the temples, vertex, and mid frontal scalp [1]. It is characterized by the miniaturization of hair follicles, shortening of the anagen (growth) phase, and increases in the percentage of telogen (resting) hair follicles, producing microscopic hairs. Androgenetic alopecia (AGA) is the most common cause of hair loss in men. We evaluated the cost-effectiveness of minoxidil monotherapy, minoxidil and platelet-rich plasma (PRP) combined therapy, and PRP monotherapy for the long-term treatment of early-onset AGA Hamilton-Norwood stages I-V in men

Objectives

Methods

Results

Discussion

Conclusion