A comprehensive analysis of clinical, quality of life, and cost-effectiveness outcomes of key treatment options for benign prostatic hyperplasia

Treatment options for men with moderate-to-severe lower urinary tract symptoms (LUTS) due to benign prostatic hyperplasia (BPH) have variable efficacy, safety, and retreatment profiles, contributing to variations in patient quality of life and healthcare costs. This study examined the long-term cost...

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Vydané v:PloS one Ročník 17; číslo 4; s. e0266824
Hlavní autori: Chughtai, Bilal, Rojanasarot, Sirikan, Neeser, Kurt, Gultyaev, Dmitry, Fu, Shuai, Bhattacharyya, Samir K., El-Arabi, Ahmad M., Cutone, Ben J., McVary, Kevin T.
Médium: Journal Article
Jazyk:English
Vydavateľské údaje: United States Public Library of Science 15.04.2022
Public Library of Science (PLoS)
Predmet:
Aged
Analysis
Biology and Life Sciences
Clinical trials
Cost analysis
Cost-Benefit Analysis
Costs
Economic aspects
Genital diseases
Government programs
Health aspects
Health care policy
Health services
Humans
Hyperplasia
Hypertrophy
Intubation
Literature reviews
Male
Markov chains
Medical fees
Medicare
Medicine and Health Sciences
Meta-analysis
Middle Aged
Patients
Physical Sciences
Prostate
Prostatic Hyperplasia - complications
Quality of Life
Social Sciences
Transurethral Resection of Prostate - adverse effects
Treatment Outcome
United States
Urinary tract
Urogenital system
Vaporization
Water vapor
United States
New York
United States > US
Germany
ISSN:1932-6203, 1932-6203
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Popis
Shrnutí:Treatment options for men with moderate-to-severe lower urinary tract symptoms (LUTS) due to benign prostatic hyperplasia (BPH) have variable efficacy, safety, and retreatment profiles, contributing to variations in patient quality of life and healthcare costs. This study examined the long-term cost-effectiveness of generic combination therapy (CT), prostatic urethral lift (PUL), water vapor thermal therapy (WVTT), photoselective vaporization of the prostate (PVP), and transurethral resection of the prostate (TURP) for the treatment of BPH. A systematic literature review was performed to identify clinical trials of CT, PUL, WVTT, PVP, and TURP that reported change in International Prostate Symptom Score (IPSS) for men with BPH and a prostate volume ≤80 cm 3 . A random-effects network meta‐analysis was used to account for the differences in patient baseline clinical characteristics between trials. An Excel-based Markov model was developed with a cohort of males with a mean age of 63 and an average IPSS of 22 to assess the cost-effectiveness of these treatment options at 1 and 5 years from a US Medicare perspective. Procedural and adverse event (AE)-related costs were based on 2021 Medicare reimbursement rates. Total Medicare costs at 5 years were highest for PUL ($9,580), followed by generic CT ($8,223), TURP ($6,328), PVP ($6,152), and WVTT ($2,655). The total cost of PUL was driven by procedural ($7,258) and retreatment ($1,168) costs. At 5 years, CT and PUL were associated with fewer quality-adjusted life years (QALYs) than WVTT, PVP, and TURP. Compared to WVTT, the incremental cost-effectiveness ratios (ICERs) for both TURP and PVP were above a willingness-to-pay threshold of $50,000/QALY (TURP: $64,409/QALY; PVP: $87,483/QALY). This study provides long-term cost-effectiveness evidence for several common treatment options for men with BPH. WVTT is an effective and economically viable treatment in resource-constrained environments.
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KN, DG and SF also contributed equally to this work.
Competing Interests: B Chughtai is a paid clinical consultant for Boston Scientific, MedeonBio, Olympus, and Allergan as well as an investigator for Teleflex. S Rojanasarot, B Cutone, and S Bhattacharyya are employees of Boston Scientific. K Neeser, D Gultyaev, and S Fu are employees of Certara Evidence & Access. K McVary is a principal investigator for NIDDK and Urovant. He is a paid clinical consultant for Boston Scientific and MedeonBio. This does not alter our adherence to PLOS ONE policies on sharing data and materials.
ISSN:1932-6203
1932-6203
DOI:10.1371/journal.pone.0266824