151557_GreenLightSummary_B 5/31/07 4:29 PM Page 18G R E E N L I G H TC L I N I C A L S T U D Y S U M M A R YMean changes in LOC and LOS, blood loss, and cost (range)TURP/ECONPvalue,Pvalue,comparisonTURP PVP change within between(n=38) (n=38) group groupsLOC (hrs.) 44.52±30.23 12.2±8.6 NS
151557_GreenLightSummary_B 5/31/07 4:29 PM Page 19G R E E N L I G H TC L I N I C A L S T U D Y S U M M A R YPhotoselective vaporization of the prostate to alternative minimallyinvasive therapies and transurethral prostate resection for thetreatment of benign prostatic hyperplasiaMark D. Stovsky,*,+ Robert I. Griffiths+ and Steven B. Duff+From the Department of Urology, Case School of Medicine, University Hospitals of Cleveland (MDS), Cleveland, Ohio, Department ofMedicine, Johns Hopkins University School of Medicine (RIG), Baltimore, Maryland, Health Economics Consulting (RIG), Craftsbury,Vermont, and Veritas Health Economics Consulting (SBD), Carlsbad, CaliforniaJ Urol 2006Purpose: We critically evaluated the clinical outcomes andcost characteristics of alternative procedural treatmentoptions for symptomatic benign prostatic hyperplasia.Materials and Methods: An outcomes and cost analysis wasperformed for benign prostatic hyperplasia treatments,including photoselective vaporization, microwavethermotherapy, transurethral needle ablation, interstitiallaser coagulation and transurethral resection. Clinicaloutcomes were measured by the percent improvement inAmerican Urological Association/International ProstateSymptom Score, the maximum uroflowmetry rate andquality of life score. An economic simulation model wasconstructed to estimate the expected cost of benignprostatic hyperplasia procedural therapies from a payerperspective. The model included costs of initial treatment,follow up care, adverse events and re-treatment. Sensitivityand threshold analyses tested the impact of changingmodel inputs on base case results.Results: Ablative therapies showed better improvement insymptom score, flow rate and quality of life score comparedto thermotherapy procedures. Photoselective vaporizationresulted in the largest beneficial changes in AmericanUrological Association/International Prostate SymptomScore, the maximum uroflowmetry rate and the quality of lifescore at all time points evaluated, followed by transurethralresection and then interstitial laser coagulation. Theestimated cost was lower for photoselective vaporizationthan for any other procedural option at any interval studied.Sensitivity analyses indicated that the results of baselineanalyses were robust to reasonable changes in clinical andeconomic inputs to the model.PVP Showed the greatest improvements in AUASS, I-PSS,QMAX and QOL across all intervals. Of the proceduraltherapies studies PVP was less costly than TURP, ILC, TUNA,and TUMT. The cost savings of this procedure stemmedfrom the rates of adverse events and re-treatment, whichon a comparative basis were lower for PVP. Also, sensitivityanalysis to assess the impact of changes in PVP re-treatmentrelative to TURP showed that the PVP re-treatment raterequired for these procedures to be cost equivalent wasmore then 3 times greater than the highest re-treatmentrate reported in the PVP literature. From this we concludethat differences in the expected cost of PVP and TURP arerobust to reasonable changes in the rate of PVP re-treatment.TURP/ECONConclusions: Compared to alternative treatment options photoselective vaporization of the prostate is a clinicallyefficacious and cost-effective treat for symptomatic benign prostatic hyperplasia.Key Words: prostate, prostatic hyperplasia, costs and cost analysis, outcome assessment (health care)
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