The Continuing Story of the Cost-Effectiveness of Photoselective Vaporization of the Prostate versus Transuretheral Resection of the Prostate for the Treatment of Symptomatic Benign Prostatic Obstruction
| Autor: | Andrew C. Thorpe, Andrea Tubaro, J. Andrew Thomas, Nigel Armstrong, Alexander Bachmann, Neil Barber, Ben van Hout |
|---|---|
| Rok vydání: | 2015 |
| Předmět: |
Male
medicine.medical_specialty Prostatic Diseases Cost effectiveness medicine.medical_treatment Cost-Benefit Analysis Prostate Health care medicine Humans benign prostatic obstruction cost effectiveness analysis health care NICE guidance United Kingdom Laser Therapy Markov Chains Transurethral Resection of Prostate Treatment Outcome Health Policy Public Health Environmental and Occupational Health Transurethral resection of the prostate business.industry General surgery Environmental and Occupational Health Cost-effectiveness analysis Confidence interval Surgery medicine.anatomical_structure Photoselective vaporization Public Health Prostatic obstruction business |
| Zdroj: | Value in Health. 18(4):376-386 |
| ISSN: | 1098-3015 |
| DOI: | 10.1016/j.jval.2015.04.002 |
| Popis: | Background In 2008, a UK assessment of technologies for benign prostatic obstruction concluded negatively about photoselective vaporization of the prostate (PVP), and the 2010 National Institute for Health and Care Excellence guidance caused several UK institutions to abandon PVP. Objective To reassess the costs and effects of PVP versus transurethral resection of the prostate (TURP) on the basis of most recent data. Methods The same model was used as in 2008. Transition probabilities were estimated using a Bayesian approach updating the 2008 estimates with data from two meta-analyses and data from GOLIATH, the latest and largest trial comparing PVP with TURP. Utility estimates were from the 2008 assessment, and estimates of resource utilization and costs were updated. Effectiveness was measured in quality-adjusted life-years gained, and costs are in UK pounds. The balance between costs and effects was addressed by multivariate sensitivity analysis. Results If the 2010 National Institute for Health and Care Excellence analysis would have updated the cost-effectiveness analysis with figures from its own meta-analysis, it would have estimated the change in quality-adjusted life-years at −0.01 (95% confidence interval [CI] −0.05 to 0.01) instead of at −0.11 (95% CI −0.31 to −0.01) as in the 2008 analysis. The GOLIATH estimate of −0.01 (95% CI −0.07 to 0.02) strengthens the conclusion of near equivalence. Estimates of additional costs vary from £491 (£21−£1286) in 2008 to £111 (−£315 to £595) for 2010 and to £109 (−£204 to £504) for GOLIATH. PVP becomes cost saving if more than 32% can be carried out as a day case in the United Kingdom. Conclusions The available evidence indicates that PVP can be a cost-effective alternative for TURP in a potentially broad group of patients. |
| Databáze: | OpenAIRE |
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