: Benign prostatic hyperplasia (BPH), the enlargement of the prostate gland, is a nearly universal phenomenon in the aging male. It is a chronic, progressive condition that can result in a tremendous change in quality of life due to lower urinary tract symptoms. Current Medicare reimbursement policies discourage the use of transurethral resection of the prostate, the most costly but most effective BPH treatment, and encourage less durable, minimally-invasive surgical therapies (MISTs) or pharmacotherapies. MISTs have high failure rates of up to 40% within 4 years, and the long-term durability of these treatments is still under evaluation. Pharmacotherapies do not necessarily provide long-term relief, and their use shifts BPH treatment costs to elderly patients depending on their Medicare prescription drug benefit. ? ? The purpose of this study is to explore the following primary Medicare policy question: In an effort to minimize healthcare expenditures for BPH, do Medicare reimbursement policies lead to poorer patient outcomes and greater costs in the long term? This study will employ decision analysis to model the clinical, humanistic, and cost consequences of different treatment strategies for the management of BPH over a 20-year time period. Cost-utility analysis including incremental cost per quality-adjusted life year and cost-effectiveness acceptability curves will be presented. In addition, results will describe the effect of treatment decisions on Medicare beneficiary health and healthcare expenditures. Given the uncertainty around the parameter estimates, particularly treatment durability, the value of obtaining additional information will be determined using the expected value of perfect information. ? ? This research question has important policy significance because of the prevalence of BPH and its anticipated costs to patients and the healthcare system. It is timely with the addition of a Medicare prescription drug benefit. Existing Medicare policies that provide disincentives for surgery may in fact be penny wise and pound foolish, resulting in higher costs and poorer patient outcomes in the long term.
| DiSantostefano, Rachael L; Biddle, Andrea K; Lavelle, John P (2006) The long-term cost effectiveness of treatments for benign prostatic hyperplasia. Pharmacoeconomics 24:171-91 |
