Cost effectiveness of treatment for benign prostatic hyperplasia: an economic model for comparison of medical, minimally invasive, and surgical therapy.
OBJECTIVE
To evaluate the cost effectiveness of minimally invasive therapy relative to medical (alpha-blocker) therapy and transurethral resection (TURP) for patients with moderate to severe symptoms of benign prostatic hyperplasia (BPH).


METHODS
We constructed a decision-analytic Markov model for a hypothetical cohort of 65-year-old men with moderate to severe BPH symptoms. Microwave thermotherapy was selected to represent minimally invasive treatment. Cost-effectiveness analysis was performed with 25 health states using the 3 treatments, 5 short-term clinical events, and 17 possible long-term outcomes. Each health state had an associated cost and utility. Quality of life (QoL) and utility estimates were obtained by interviewing 13 men with BPH symptoms using the standard gamble reference methods. Patients were classified as risk averse (RA) or non-risk averse (NRA) on the basis of their attitudes to risk. We calculated the incremental cost effectiveness of microwave thermotherapy relative to medical therapy and TURP over 5 years after treatment initiation. Event probabilities were obtained from the literature, a consensus panel, and published randomized clinical trials.


CONCLUSIONS
The utility values generated were internally consistent and externally valid for a hypothetical cohort of 10,000 RA patients. Microwave thermotherapy was preferred by the NRA group, while medical therapy was preferred by the RA group. Surgery was least preferred by both groups. Microwave thermotherapy had a small incremental cost but improved QoL in comparison with medical therapy. Microwave thermotherapy had a higher utility and lower cost than TURP and thus was dominant over TURP. This analytical method can be applied to evaluate the cost effectiveness of any BPH therapy.
Manyak
Michael J
MJ
Department of Urology, The George Washington University Medical Center, Washington, DC 20037, USA. uromjm@gwumc.edu
Ackerman
Stacey J
SJ
Blute
Michael L
ML
Rein
Alison L
AL
Buesterien
Kathleen
K
Sullivan
Erin M
EM
Tanio
Craig P
CP
Strauss
Michael J
MJ
D000368:Aged; D003362:Cost-Benefit Analysis; D006801:Humans; D006979:Hyperthermia, Induced; D008297:Male; D019060:Minimally Invasive Surgical Procedures / Q000191:economics*; D018803:Models, Economic; D011470:Prostatic Hyperplasia / Q000191:economics / Q000628:therapy*; D011788:Quality of Life; D012307:Risk Factors; D020728:Transurethral Resection of Prostate / Q000191:economics*