■良性前列腺增生(BPH)在日本是一个重要的公共卫生问题。这项研究从日本公共医疗保健提供者的角度评估了水蒸气能量疗法(WAVE)与前列腺尿道提升术(PUL)对中度至重度BPH男性的终生成本效益。
■一种决策分析模型,比较了日本男性的WAVE和PUL。临床有效性和不良事件(AE)输入来自系统文献综述。资源利用和成本投入来自日本的医疗数据视觉数据库和医疗服务费国家数据。专家审查并验证了模型输入参数。进行了单向和概率敏感性分析,以确定不确定参数值的变化如何影响模型结果。
■在整个患者的一生中,WAVE与更高的质量调整寿命年(0.920vs.0.911年1;15.564与15.388终身)和更低的总成本(¥734,134与¥888,110年1;¥961,595vs.¥1,429,458寿命)与PUL相比,表明WAVE是一种更有效、成本更低的方法(即,主导)跨越所有时间范围的治疗策略。每位接受WAVE而不是PUL治疗的患者的日本医疗保健系统的终身成本节省为467,863日元。WAVE和PUL之间32.7%的成本差异主要是由较低的WAVE手术再治疗率(4.9%vs.WAVE与PUL的19.2%,分别,5年时)和AE发生率(血尿11.8%与25.7%,排尿困难16.9%vs.34.3%,骨盆疼痛2.9%vs.17.9%,和尿失禁0.4%vs.WAVE与PUL的1.3%,分别,在3个月)。模型发现对参数输入值的变化具有鲁棒性。
■该模型代表了资源分配决策中涉及的复杂因素的简化。
■在较低的再治疗和AE率的驱动下,与PUL相比,WAVE是日本中重度BPH的一种具有成本效益且节省成本的治疗方法,以更低的成本为医疗保健系统提供更好的结果。
良性前列腺增生(BPH)在日本是一个重要的公共卫生问题,鉴于其在快速老龄化人口中的高患病率和潜在发病率。本研究比较了两种微创手术治疗BPH的临床和经济效果(水蒸气能量疗法[WAVE]与前列腺尿道提升[PUL])适用于日本患者。临床有效性和不良事件(AE)信息来自已发表的医学文献,以及来自日本的真实医疗服务和成本数据,用于估计两种治疗的影响。与PUL相比,发现WAVE为患者提供更好的临床结果和生活质量,同时对日本医疗保健系统的成本较低。使用WAVE治疗的患者的终生质量调整寿命年较高。接受PUL治疗的患者(15.564vs.15.388)。使用WAVE代替PUL治疗的每位患者的日本医疗保健系统的终身成本节省估计为467,863日元。WAVE和PUL之间32.7%的成本差异主要是由于WAVE的再治疗率较低(手术再治疗率为4.9%vs.WAVE与WAVE的19.2%PUL,分别,5年时)和AE率(WAVE与3个月时的AE率PUL,分别,分别为:血尿11.8%vs.25.7%,排尿困难16.9%vs.34.3%,骨盆疼痛2.9%vs.17.9%,和尿失禁0.4%vs.1.3%)。这些发现为临床医生提供了基于证据的见解,付款人,和卫生政策制定者进一步定义WAVE在日本BPH中的作用。
UNASSIGNED: Benign prostatic hyperplasia (BPH) represents a significant public health issue in Japan. This study evaluated the lifetime cost-effectiveness of water vapor energy therapy (WAVE) versus prostatic urethral lift (PUL) for men with moderate-to-severe BPH from a public healthcare payer\'s perspective in Japan.
UNASSIGNED: A decision analytic model compared WAVE to PUL among males in Japan. Clinical effectiveness and adverse event (AE) inputs were obtained from a systematic literature review. Resource utilization and cost inputs were derived from the Medical Data Vision database and medical service fee national data in Japan. Experts reviewed and validated model input parameters. One-way and probabilistic sensitivity analyses were conducted to determine how changes in the values of uncertain parameters affect the model results.
UNASSIGNED: Throughout patients\' lifetimes, WAVE was associated with higher quality-adjusted life years (0.920 vs. 0.911 year 1; 15.564 vs. 15.388 lifetime) and lower total costs (¥734,134 vs. ¥888,110 year 1; ¥961,595 vs. ¥1,429,458 lifetime) compared to PUL, indicating that WAVE is a more effective and less costly (i.e. dominant) treatment strategy across all time horizons. Lifetime cost-savings for the Japanese healthcare system per patient treated with WAVE instead of PUL were ¥467,863. The 32.7% cost difference between WAVE and PUL was predominantly driven by lower WAVE surgical retreatment rates (4.9% vs. 19.2% for WAVE vs PUL, respectively, at 5 years) and AE rates (hematuria 11.8% vs. 25.7%, dysuria 16.9% vs. 34.3%, pelvic pain 2.9% vs. 17.9%, and urinary incontinence 0.4% vs. 1.3% for WAVE vs PUL, respectively, at 3 months). Model findings were robust to changes in parameter input values.
UNASSIGNED: The model represents a simplification of complex factors involved in resource allocation decision-making.
UNASSIGNED: Driven by lower retreatment and AE rates, WAVE was a cost-effective and cost-saving treatment for moderate-to-severe BPH in Japan compared to PUL, providing better outcomes at lower costs to the healthcare system.
Benign prostatic hyperplasia (BPH) is an important public health issue in Japan, given its high prevalence and potential morbidity in a rapidly aging population. This study compared the clinical and economic outcomes of two minimally invasive surgical treatments for BPH (water vapor energy therapy [WAVE] vs. prostatic urethral lift [PUL]) for patients in Japan. Clinical effectiveness and adverse event (AE) information from published medical literature, and real-world health services and cost data from Japan, were used to estimate the impact of the two treatments. Compared to PUL, WAVE was found to provide better clinical outcomes and quality-of-life for patients whilst costing less to the Japanese healthcare system. Patients treated with WAVE had higher lifetime quality-adjusted life years vs. patients treated with PUL (15.564 vs. 15.388). Lifetime cost-savings for the Japanese healthcare system per patient treated with WAVE instead of PUL were estimated to be ¥467,863. The 32.7% cost difference between WAVE and PUL was predominantly driven by lower retreatment rates for WAVE (surgical retreatment rate was 4.9% vs. 19.2% for WAVE vs. PUL, respectively, at 5 years) and AE rates (AE rates at 3 months for WAVE vs. PUL, respectively, were: hematuria 11.8% vs. 25.7%, dysuria 16.9% vs. 34.3%, pelvic pain 2.9% vs. 17.9%, and urinary incontinence 0.4% vs. 1.3%). These findings provide evidence-based insights for clinicians, payers, and health policymakers to further define the role of WAVE for BPH in Japan.