Clinical, Quality of Life, and Cost-Effectiveness Outcomes of Combination Therapy and Minimally Invasive Surgical Treatments for Benign Prostatic Hyperplasia
Author(s)
ABSTRACT WITHDRAWN
OBJECTIVES Men with moderate-to-severe lower urinary tract symptoms due to benign prostatic hyperplasia (BPH) are often prescribed medical therapy to manage their symptoms. Convective water vapor thermal therapy (WVTT) and prostatic urethral lift (PUL) are minimally invasive surgical treatments as an alternative to medication. This study examined the clinical and patients’ quality of life (QOL) benefits as well as long-term cost-effectiveness of generic fixed-dose combination therapy of tamsulosin and dutasteride (CT), WVTT, and PUL for men with moderate-to-severe BPH. METHODS A systematic literature review was performed to identify randomized and non-randomized clinical trials of CT, WVTT, and PUL for men with moderate to severe BPH and prostate volume <80 g. We used a random-effects network meta‐analysis (NMA) to account for the baseline differences between trials. An Excel-based Markov model was developed to examine the cost-effectiveness of generic CT, WVTT, and PUL at 5 years from a U.S. Medicare perspective. Procedural and adverse event-related costs are based on 2021 Medicare reimbursement rates. Medication costs were from 2019 Medicare Part D Drug Spending inflated to 2021 dollars. RESULTS The NMA found that after controlling for baseline age and IPSS, WVTT had the greatest International Prostate Symptom Score (IPSS) improvement followed by PUL and CT, respectively. At 5 years, WVTT had the greatest quality-adjusted life-year compared to PUL and CT. The total costs to Medicare at 5 years were $9,580 for PUL, $8,223 for generic CT, and $2,655 for WVTT. PUL had the highest index treatment and retreatment costs. Since WVTT was more effective in improving patients' QOL and less costly compared to generic CT and PUL, WVTT was the dominant treatment option. CONCLUSIONS WVTT was the most cost-effective treatment option for men with BPH compared to PUL and CT while providing clinical and QOL benefits to the patients and cost-savings to Medicare.
Conference/Value in Health Info
2021-11, ISPOR Europe 2021, Copenhagen, Denmark
Value in Health, Volume 24, Issue 12, S2 (December 2021)
Code
POSC147
Topic
Economic Evaluation
Topic Subcategory
Cost-comparison, Effectiveness, Utility, Benefit Analysis
Disease
Drugs, Medical Devices, Surgery, Urinary/Kidney Disorders