title: Office-Based HE-TUMT Costs Less than Medication over Four Years in Treating Benign Prostatic Hyperplasia.
abstract: OBJECTIVE
  Benign prostatic hyperplasia (BPH) can cause lower urinary tract symptoms (LUTS). Medications are first line treatment for mild-moderate BPH. Office-based minimally invasive therapies (MITs) are also acceptable early treatment options but comparisons of MIT to medications are limited. MIT may be equally effective and less costly compared to long-term medical therapy. We compared data from a medication trial to pooled data of high-energy transurethral microwave therapy (HE-TUMT) to evaluate differences in outcomes and costs between the modalities.
  
  
  METHODS
  Covariate-adjusted comparison of treatments from independent clinical trials.
  
  
  METHODS
  Data from Medical Therapy of Prostatic Symptoms (MTOPS) study arms were compared to Urologix pooled data from seven HE-TUMT studies at 25 centers. Improvements in voiding symptoms and quality of life (QoL) were determined and a repeated measure logistic regression analysis to control for baseline covariates was performed. Cost data were collected using published outcomes, Medicare 2013 national averages, and discount online pharmacy prices.
  
  
  RESULTS
  HE-TUMT provided significant improvement in voiding symptoms and QoL compared to all MTOPS arms through two years. At four years, all therapies maintain similar improvements when adjusting for baseline covariates. Four year cumulative costs of HE-TUMT ($3,620) were less than combination medical therapy ($7,200).
  
  
  CONCLUSIONS
  HE-TUMT provides better improvement of LUTS compared to medication for two years. At four years, all therapies provide comparable improvement but HE-TUMT is less expensive with better QoL. This suggests that HE-TUMT is an excellent alternative to medical therapy that should be routinely discussed and offered during detailed management of BPH.
authors.affiliation: Department of Surgery, Urology Section, VA Boston Healthcare System, Boston, MA.
authors.forename: Lori B
authors.initials: LB
authors.lastname: Lerner
authors.affiliation: Department of Surgery, Urology Section, VA Boston Healthcare System, Boston, MA.
authors.forename: Portia
authors.initials: P
authors.lastname: Thurmond
authors.affiliation: Technomics Research, Minneapolis, MN.
authors.forename: Manya R
authors.initials: MR
authors.lastname: Harsch
authors.affiliation: School of Public Health and Technomics Research, University of Minnesota, Minneapolis, MN.
authors.forename: Melissa S
authors.initials: MS
authors.lastname: Martinson
mesh_terms: D000368:Aged; D000553:Ambulatory Care; D006801:Humans; D008297:Male; D008875:Middle Aged; D011470:Prostatic Hyperplasia / Q000188:drug therapy* / Q000453:epidemiology / Q000601:surgery*; D011788:Quality of Life; D012189:Retrospective Studies; D020728:Transurethral Resection of Prostate / Q000191:economics* / Q000379:methods*; D016896:Treatment Outcome; D064804:Urological Agents / Q000191:economics* / Q000627:therapeutic use*
chemical_list: D064804:Urological Agents