PD64-07 DETERMINING THE MOST COST-EFFECTIVE LASER PROCEDURE FOR BENIGN PROSTATIC HYPERPLASIA

Abstract

You have accessJournal of UrologyBenign Prostatic Hyperplasia: Surgical Therapy & New Technology III1 Apr 2018PD64-07 DETERMINING THE MOST COST-EFFECTIVE LASER PROCEDURE FOR BENIGN PROSTATIC HYPERPLASIA Laurel Sofer, Simone Crivellaro, and Paolo Serafini Laurel SoferLaurel Sofer More articles by this author , Simone CrivellaroSimone Crivellaro More articles by this author , and Paolo SerafiniPaolo Serafini More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2018.02.2979AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail INTRODUCTION AND OBJECTIVES Laser procedures for benign prostatic hyperplasia (BPH) offer improved patient outcomes, but at an added cost. With the rising costs of healthcare and a shift towards value-based payments, identification of the most cost-effective treatment for an individual patient is increasingly important for the practicing urologist. The Markov model created in this study assumes a reimbursement model with a prefixed budget and provides a practical tool to determine the most cost-effective laser procedure for BPH after failing pharmacologic therapy. METHODS A Markov chain was created based on a set of health states for BPH. Utilities of each state were obtained from the literature and from these, disutility values were calculated (Disutility = 1 - utility). Transition probabilities were determined using mean changes in IPSS scores for Greenlight PVP (GL), Transurethral resection of the prostate (TURP), Holmium laser enucleation (HL) and Thulium laser enucleation (TH) from the available literature and expert opinion. Cost analysis was performed using outcomes and adverse event data from the literature for each of the laser procedures and hospital costs from hospital administration. Linear programming was used to compute the average cost versus a given disutility threshold in a Markov decision model. Base-case analyses and sensitivity testing were performed. RESULTS By varying the maximum disutility value, an average cost is determined from the model and a cost-effectiveness curve was created. The curves demonstrate the tradeoffs between disutility and cost for each procedure and overall (Graph 1). From the latter curve, one can determine the most cost-effective procedure for each health state at a given maximum disutility (Table 1) and the breaking point is at a disutility of 0.15. CONCLUSIONS This model allows urologists to select the most cost-effective surgical procedure for their patients with BPH. Limitations include reliance on data from the literature available and lack of information about incontinence rates. Further studies are needed to validate the model. © 2018FiguresReferencesRelatedDetails Volume 199Issue 4SApril 2018Page: e1221-e1222 Advertisement Copyright & Permissions© 2018MetricsAuthor Information Laurel Sofer More articles by this author Simone Crivellaro More articles by this author Paolo Serafini More articles by this author Expand All Advertisement Advertisement PDF downloadLoading ...