Optimizing Population Health and Economic Outcomes: Innovative Treatment for BPH

Janice, L ClarkeTranscribed and adapted for publication by

doi:10.1089/pop.2013.1691

Cited by 5 publications

(6 citation statements)

References 34 publications

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“…Briefly, the UroLIFT system is a series of cystoscopically‐placed implants that are placed from the other prostate capsule to the inner luminal aspect of the prostate, and work to manually retract the prostate lobe under tension. This has good effects in improving a patients symptoms scores but is associated with haematuria and dysuria. It has been approved for use in the most recent European Association of Urology guidelines, though long‐term efficacy data is still unavailable .…”

Section: Prostate Pathologies and Mechanical Characteristicsmentioning

confidence: 99%

Direct mechanical characterization of prostate tissue—a systematic review

Kelly¹,

Flood²,

Hoey

et al. 2018

The Prostate

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Section: Prostate Pathologies and Mechanical Characteristicsmentioning

confidence: 99%

Direct mechanical characterization of prostate tissue—a systematic review

Kelly¹,

Flood²,

Hoey

et al. 2018

The Prostate

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“…9 In addition, PUL has also been found to have cost-savings associated with its ability to be performed as an outpatient procedure and its low complication rates. 10,11 Modeling the UK National Institute for Health and Care Excellence showed that when PUL is performed as an outpatient surgery, PUL produced savings of £286 per patient compared to monopolar TURP £159 per patient compared to bipolar TURP and £90 per patient compared to holmium laser enucleation of the prostate (HoLEP). 11 The efficacy of PUL was initially demonstrated in a clinical trial with 5-year follow-up, in the Luminal Improvement Following Prostatic Tissue Approximation (LIFT) study by Roehrborn et al [12][13][14][15] This sham-controlled trial with 206 subjects showed IPSS improvement of 41.1% at 3 years and 36% at 5 years.…”

Section: Introductionmentioning

confidence: 99%

“…While TURP carries a small risk of post‐operative erectile dysfunction (ED), studies have demonstrated that PUL may actually even improve the Sexual Health Inventory in Men (SHIM) score in men with severe erectile dysfunction (ED) 9 . In addition, PUL has also been found to have cost‐savings associated with its ability to be performed as an outpatient procedure and its low complication rates 10,11 . Modeling the UK National Institute for Health and Care Excellence showed that when PUL is performed as an outpatient surgery, PUL produced savings of £286 per patient compared to monopolar TURP £159 per patient compared to bipolar TURP and £90 per patient compared to holmium laser enucleation of the prostate (HoLEP) 11…”

Section: Introductionmentioning

confidence: 99%

“… 9 In addition, PUL has also been found to have cost‐savings associated with its ability to be performed as an outpatient procedure and its low complication rates. 10 , 11 Modeling the UK National Institute for Health and Care Excellence showed that when PUL is performed as an outpatient surgery, PUL produced savings of £286 per patient compared to monopolar TURP £159 per patient compared to bipolar TURP and £90 per patient compared to holmium laser enucleation of the prostate (HoLEP). 11…”

Section: Introductionmentioning

confidence: 99%

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Outcomes of prostatic urethral lift in a medically complex population at a veterans affairs hospital

et al. 2021

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Objective: The objective of this study is to report "real-world" outcomes of prostatic urethral lift (PUL) in a medically complex US military veteran population while employing liberalized procedural indications.Methods: A retrospective review was conducted of patients who underwent PUL at our institution. There were no prostatic size requirements, patients were accepted on anti-platelet/anticoagulant therapy, no benign prostatic hyperplasia (BPH) medication washout was required, and there was no maximum post-void residual PVR.Pre-and post-operative International Prostate Symptom Score (IPSS), uroflowmetry, and PVR were recorded. Statistical comparisons were performed using simple t tests.Results: From 2013 to 2019, 91 patients underwent PUL. Mean age was 70 (range 55-92) years. The majority of our patients were classified as American Society of Anesthesiologists (ASA) class 3 versus the general population at ASA class 2. Postoperatively, IPSS decreased by an average of 43% (23 to 13, p < 0.001). There was a mean 41% decrease in PVR (179 to 101 cc, p = 0.009), which was durable for a follow-up of up to 54 months. Maximum urinary flow rate improved by an average of 32% (9.3 to 12.3 cc/s, p = 0.003), which was also durable throughout followup. Forty-four patients required catheterization pre-operatively and 16 required catheterization post-operatively. Therefore, 27 patients (61.4%) were rendered catheter-free by PUL. Thirty-nine patients were taking antiplatelet medications perioperatively, and 13 took anticoagulants. Only one patient (on warfarin) experienced hematuria requiring re-admission with catheter placement.Conclusions: PUL produced effective and durable results in our veteran population, including in patients with significant pre-operative bladder decompensation and those on antiplatelets/anticoagulants.

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“…Recent studies of individuals with employer-sponsored insurance have described utilization patterns for preventive services, 7 delays in care, 8 as well as hospital admissions and emergency department visits, 9 but few have considered this information in light of social determinants of health, such as worker wage level 1 or place of residence. 10 To date, none have explored the prevalence of social determinants of health with associated clinical risk factors for common medical conditions within a large commercially insured population.…”

Section: Introductionmentioning

confidence: 99%

Social Determinants of Health Challenges Are Prevalent Among Commercially Insured Populations

Pera

Cain

Emerick

et al. 2021

J Prim Care Community Health

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Objectives: To evaluate the prevalence of social determinants of health (SDoH) factors in a large commercially-insured population and to characterize the prevalence of common conditions (eg, diabetes, behavioral health issues) and addressable health services utilization concerns (eg, lack of preventive care) for which employers offer no- and low-cost benefit programs. Methods: We identified groups with SDoH challenges within a commercially-insured population of 5.1 M through administrative data and self-report. Using medical claims and health assessment data, we identified populations with SDoH needs who had common conditions for which employers often provide no- or low-cost benefit programs (ie, diabetes, behavioral health conditions, high-risk pregnancy, overweight/obesity). Additionally, we sought populations with common addressable health services utilization concerns such as avoidable emergency room visits, lack of preventive care services, or non-adherence to medications. We used univariate analyses to describe the prevalence of SDoH risks in the population of interest. Results: Twenty-seven percent of this commercially-insured population live in a zip code where the median income is at or below 200% of the Federal Poverty Line. Respondents identified cost (55%) and family, school, or work responsibilities (26%) as key barriers to care. ER overutilization rates are higher in lower income zip codes than wealthier zip codes (34% vs 9%) as is the prevalence of diabetes, overweight/obesity, and behavioral issues, and decreased use of preventive services. Fifteen percent of the study population live in a low-access food area. There is considerable variability in access to employer-sponsored resources to address these needs (70% of employers provide behavioral health programs; 63% provide telehealth programs, but only 1% offer healthy food programs and less than 0.5% offer either child care or transportation support programs). Conclusions: Commercially insured populations could benefit from employer-sponsored programs or benefits that address key SDoH barriers such as financial support, healthy food programs, child-care, and transportation.

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Optimizing Population Health and Economic Outcomes: Innovative Treatment for BPH

Cited by 5 publications

References 34 publications

Direct mechanical characterization of prostate tissue—a systematic review

Direct mechanical characterization of prostate tissue—a systematic review

Outcomes of prostatic urethral lift in a medically complex population at a veterans affairs hospital

Social Determinants of Health Challenges Are Prevalent Among Commercially Insured Populations

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