Cost-effectiveness analysis of six therapies for the treatment of lower urinary tract symptoms due to benign prostatic hyperplasia

Abstract

ObjectiveTo conduct a cost-effectiveness analysis from payers’ perspectives of six treatments for lower urinary tract symptoms (LUTS) associated with benign prostatic hyperplasia (BPH) and to examine positioning of these modalities in the marketplace for the best use of health care funds and quality-of-life benefits for patients.MethodsThe economic analysis was conducted with a Markov model to compare combination prescription drug therapy (ComboRx), minimally invasive therapies (MITs) including convective radiofrequency (RF) water vapor thermal therapy (Rezūm®), conductive RF thermal therapy (Prostiva®), and prostatic urethral lift (UroLift®), and invasive surgical procedures including photovaporization of the prostate (Greenlight® PVP) and transurethral resection of the prostate (TURP). Effects assessed with International Prostate Symptom Score, adverse events, and re-treatment rates were estimated from medical literature; treatments effects were modeled using a common baseline score. Starting with each therapy, patients’ transitions to more intensive therapies when symptoms returned were simulated in 6-month cycles over 2 years. Incremental cost-effectiveness ratios (ICERs) were calculated for pairs of treatments; uncertainty in ICERs was estimated with probabilistic sensitivity analyses.ResultsComboRx was least effective and provided one-third of the symptom relief achieved with MITs. UroLift was similar in effectiveness to Prostiva and Rezūm but costs more than twice as much. The cheaper MITs were ~$900 more expensive than the cost of ComboRx generic drugs over 2 years. TURP and PVP provided slightly greater relief of LUTS than MITs at approximately twice the cost over 2 years; typically, they are reserved for treatment of more severe LUTS.ConclusionThe analysis evaluated the costs and symptom relief of six treatment options in the continuum of care from a common baseline of LUTS severity. Identification of treatments for LUTS/BPH that demonstrate cost-effectiveness and provide appreciable symptom relief is paramount as reimbursement for patient care moves from volume-based services to value-based services.

Rezūm Water Vapor Thermal Therapy for Lower Urinary Tract Symptoms Associated With Benign Prostatic Hyperplasia: 4-Year Results From Randomized Controlled Study

“…The advantages of the Rezum water vapor thermal therapy compare favorably with other options, and can achieve cost equivalence to combination medical therapy within a few years. 24,25 Relative to reimbursement for this procedure, the AMA/CPT Coding Committee announced that Rezum meets all the stringent requirements for a unique Category I CPT Code. CPT 53854 became effective in January 2019.…”

Population‐based assessment of re‐treatment and healthcare utilisation after photoselective vaporisation of the prostate or electrosurgical transurethral resection of the prostate

“…Our present results will also be valuable for future economic analyses. Cost‐utility models usually rely on clinical trial data comparing PVP to electrosurgical‐TURP to justify the use of the more expensive PVP technology ; our study suggests that there are important differences in the utilisation and outcomes of PVP when it is implemented on a large scale in the general urological community, and these are of obvious relevance to such analyses. In addition, the long‐term differences between treatment modality (such as need for re‐treatment) are not always considered in these analyses and would have a considerable impact on cost‐effectiveness.…”

Significance of the pharmacoeconomic approach in the choice of treatment of hyperplasia of the prostate

“…Urologicheskie vedomosti. 2019;9(4): [59][60][61][62][63][64][65][66][67][68][69][70][71][72]. https://doi.org/10.17816/uroved9459-72 ВВЕДЕНИЕ Увеличение продолжительности жизни населения приводит к возрастанию доли лиц пожилого и старческого возраста [1].…”

“…Методика уретрального лифтинга по функциональным результатам была сходна с акваабляцией, но ее стоимость в три раза выше последней (6386 долл.) [64].…”

“…Важным преимуществом МИТ является возможность избежать госпитализации в большинстве случаев, что существенно снижает расходы на их использование. Акваабляция по стоимости, клинической эффективности и безопасности лечения ГПЖ демонстрирует преимущества и может служить первой линией и альтернативой медикаментозной терапии ГПЖ у мужчин с умеренными и тяжелыми СНМП, в том числе с большой средней долей [64].…”