Evaluating Reimbursement Policies for BPH Treatment Final rept. (Sept. 30, 2004-Aug. 31, 2005)

摘要

This dissertation examines the long-term cost-effectiveness and cost-consequences of treatment alternatives for the treatment of BPH over a 20-year period using a Markov model. Treatment alternatives compared included watchful waiting, pharmaceuticals (alpha-blockers, 5-alpha-reductase inhibitors (5-ARIs), and combination therapy), transurethral microwave thermotherapy (TUMT), and transurethral resection of the prostate (TURP). Cost-effectiveness analysis and cost-consequences analysis were employed. The policy implications of the model and need for additional research were assessed using value of information analysis. Data for the analysis were extracted from BPH recent treatment guidelines and systematic reviews, and traditional cost-effectiveness methods were employed. Alpha (alpha-) blockers and TURP were more cost-effective than alternatives for patients with moderate and severe symptoms, respectively, relative to the alternatives. For patients with severe symptoms, TURP remains the gold standard but TUMT was promising among the oldest old, providing a cost-effective treatment that was less expensive and less invasive than surgery. Examining the cost-consequences, alpha-blockers were the least expensive active treatment; however, they had little effect on clinical outcomes including BPH progression relative to other active treatments, suggesting that they do not treat the underlying disease. Other treatments, offer more benefits than alpha-blockers with regard to lower disease progression and improved clinical outcomes; however, the benefits come at an increased price. The value of information analysis demonstrated that additional research into BPH treatment alternatives is merited.