PowerPoint Slideshow about '良性前列腺肥大病患之藥物經濟學研究' - joel-skinner
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Benign prostate hyperplasia (BPH) is one of the most common chronic diseases in aging male around the globe, and the main cause of lower urinary tract symptoms (LUTS), which seriously compromising the patients’ quality of life. Thus the clinical treatment options of BPH have been discussed broadly, and the long-term cost-effectiveness analysis of variable treatment models has become the main interest topics of geriatrics in North America and Europe.
This study accessed the National Health Insurance database, utilizing data from all 4 groups of Random-Sampled Individual Insure Files (R01, R02, R03 and R04) from year 1997 to 2004, a total of 19,510 men, 108,630 records, and 114,953 prescriptions. A retrospective study has been performed, the trend of therapy and direct medical costs of BPH medications was analyzed; also the success rate between different therapeutic models and their cost-effectiveness were discussed, to provide healthcare decision-maker and healthcare authority a reference for choosing the most cost-effective therapeutic model.
The study reveals that, from 1997 to 2004, the prevalence of Taiwanese male less than 50 years old with BPH is about 1.4%, and increased to 44.6% for male over 70 years old. An average of 14.6% patients has comobidities like AUR, UTI or incontinence, and UTI is most commonly seen (10.3%). The most common therapy for BPH patient is single-agent α1-adrenergic blocker (56%), increasing yearly (R2=0.97, p<0.001).
Looking back at the average direct medical cost of different therapies from 1997 to 2004, we found out that the direct medical cost of surgery (NTD 52,270) was much higher in the first-year than others, the lowest cost is that of watchful waiting (NTD 10,173); however, single-agent 5α-reductase inhibitor treatment has the highest direct medical cost (NTD 12,117) in subsequent years, while surgery cost the least (NTD 2,586).
In the cost-effectiveness analysis of various therapies, surgery is more cost-effective compared with α1-adrenergic blocker single therapy, each 1 % incremental treatment success rate cost only an extra of NTD 9,744. Although 5α-reductase inhibitor single therapy and 5α-reductase inhibitor combined with α1-adrenergic blocker both have higher successful treatment rates than α1-adrenergic blocker alone or watchful waiting, but it’s less economic than surgery.
According to the results of this study, the future treatment of mild BPH patients should be early introduction of α1-adrenergic blocker, which would be helpful for control LUTS. The recommended treatment for moderate to severe BPH patients is surgery, which is more cost-effective than α1-adrenergic blocker single therapy, 5α-reductase inhibitor single therapy, or a combination of α1-adrenergic blocker and 5α-reductase inhibitor. However, the ‘best’ treatment depends on the value that an individual and society place on costs and consequences. Therefore, more information about patient preferences and risk evaluation is needed to inform treatment decision-making for BPH.