COST-EFFECTIVENESS MARKOV MODEL

THE JOURNAL OF UROLOGYâ

Vol. 191, No. 4S, Supplement, Tuesday, May 20, 2014

versus 6.9 days) were significantly reduced in the BPEP group. Recatheterization for acute urinary retention was more frequent after OP (8.6% versus 1.4%), while the early irritative symptoms’ rates were similar subsequent to BPEP and OP (11.4% versus 7.1%). During the 3 year’ follow-up period, no statistically significant differences were determined in terms of IPSS, Qmax, QoL, PVR, PSA level and postoperative prostate volume between the two series. Consequently, the calculated prostate volume decreases (82.7-84.7% versus 81.0-83.9%) and PSA level reductions (90.2-92.5% versus 89.8-92.6%) by comparison to preoperative measurements were statistically equivalent in the BPEP and OP study arms. CONCLUSIONS: BPEP represents a promising endoscopic approach in large BPH cases, characterized by good surgical efficiency and similar BPH tissue removal capabilities when compared to standard OP. Plasma enucleation patients benefited from a superior perioperative safety profile, significantly fewer complications, substantially faster postoperative recovery and satisfactory long term follow-up symptom scores and voiding parameters. Source of Funding: None

MP71-05 COST-EFFECTIVENESS MARKOV MODEL COMPARING HIGHAND LOW-ENERGY TRANSURETHRAL MICROWAVE THERAPY FOR BENIGN PROSTATIC HYPERPLASIA James C. Ulchaker, MD FACS*, Cleveland, OH; Melissa Martinson, MS PhD, Minneapolis, MN INTRODUCTION AND OBJECTIVES: Transurethral microwave therapy (TUMT) can be grouped into low-energy (LE-TUMT) and high-energy (HE-TUMT) categories based on both microwave wattage and intraprostatic temperatures. Historical retreatment rates, meta-analyses and disease management guidelines point to greater durability and clinical effectiveness of HE-TUMT, but cost effectiveness has not previously been compared. We created an economic model comparing cost-effectiveness of LE-TUMT and HE-TUMT. METHODS: We constructed a Markov model similar to published models on Benign Prostatic Hyperplasia (BPH) procedures using published outcomes and 2013 Medicare costs. American Urological Association Symptom scores (AUASS), adverse events (AEs), and retreatment rates at annual intervals were obtained from the literature. Costs to treat AEs and retreatment rates were included in calculating total costs. Quality Adjusted Life Years (QALYs) were calculated from preference weights from the literature for health states of BPH, successfully treated BPH, treated BPH with erectile dysfunction, and treated BPH with urinary incontinence, over the time spent in each. RESULTS: The table below shows total costs, mean AUASS, and QALYs at 2 and 4 years. Using an incremental cost-effectiveness ratio (ICER) at 4 years, HETUMT dominated LE-TUMT where HE-TUMT was more effective and less expensive over time. HE-TUMT saved $3,026 at 4 years and achieved 3 points of greater symptom score improvement, saving $868 per incremental point reduction. CONCLUSIONS: Due to higher retreatment rates, LE-TUMT is more expensive than HE-TUMT at 2 and 4 years and less effective. While HE-TUMT dominates LE-TUMT in cost effectiveness in this model, additional studies should compare these costs to BPH medication and surgical therapies. While Medicare costs are clearly lower for drugs on day 1 and higher for surgery on day 1, this type of model has the potential to help identify cost effective options across treatment modalities over the course of time.

Source of Funding: Urologix, Inc.

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MP71-06 CROSSOVER STUDY OF THE PROSTATIC URETHRAL LIFT: ANALYSIS OF INDIVIDUAL LOWER URINARY TRACT SYMPTOMS Henry Woo*, Sydney, Australia; Anthony Cantwell, Daytona Beach, FL; William Bogache, Myrtle Beach, SC; Stephen Richardson, Salt Lake City, UT; Ronald Tutrone, Towson, MD; Jack Barkin, Woodbridge, Canada; James Fagelson, Englewood, CO; Peter Chin, Figtree, Australia INTRODUCTION AND OBJECTIVES: To analyze the effect of the Prostatic Urethral Lift (PUL) on lower urinary tract symptoms (LUTS) through a multi-center, prospective crossover design study. METHODS: This study included 53 subjects who underwent a sham procedure through a prospective, randomized, controlled, blinded study at 19 centers in North America and Australia and then elected after unblinding at 3 months to undergo crossover PUL. Sham procedure involved rigid cystoscopy with simulated active treatment sounds. PUL involved placing permanent UroLiftâ implants into the lateral lobes of the prostate to enlarge the urethral lumen. Through 1 year follow up, assessments were made concerning symptoms, quality of life, urinary flow rate, sexual function, and adverse events. Analysis of each IPSS parameter allowed for assessment of specific symptom responses to treatment. RESULTS: The effect of the PUL on LUTS was found to be substantially greater than the sham response (Table 1, p-Value < 0.001). Analysis of the individual symptoms assessed through the IPSS demonstrated durable and significant improvement from baseline in all symptom parameters from 1 through 12 months (Figure 1, all p-Values < 0.02). Qmax increased after PUL and remained improved at 2.9 ml/s at 12 months (Table 1, p-Value < 0.001). Adverse events associated with the procedure were typically transient and mild to moderate. One subject (2%) required TURP in the first year. There were no occurrences of de novo, sustained ejaculatory or erectile dysfunction. Further, sexual function measures in the erectile, ejaculatory, and ejaculatory bother domains improved after PUL at every time point. CONCLUSIONS: The Prostatic Urethral Lift can provide rapid, durable symptom relief and flow rate improvements without exposing the patient to unsatisfactory perioperative risk. LUTS improves in both storage and voiding domains. The procedure can be performed under local anesthesia and allows subjects to quickly return to normal activity. PUL may be uniquely suited to treat LUTS while preserving sexual function. Table 1: Baseline, follow-up, and change in each outcome measure after control sham therapy followed by crossover PUL in the same patient cohort. Each parameter is presented as mean  standard deviation. Outcome Measure (N

Control

Control

[paired sample

Sham:

Sham: 3

Sham:

PUL:

PUL: 3

PUL:

size)

Baseline

Months

Change

Baseline

Months

Change

p-Value

AUASI (53)

25.2  5.7

20.2  8.3

-5.0  7.5

23.4  5.5

12.3  7.9

-11.1  7.2

< 0.001

QOL (52)

4.8  1.1

3.9  1.6

-0.8  1.4

4.5  1.2

2.2  1.5

-2.3  1.7

< 0.001

BPHII (52)

7.2  3.2

5.3  3.2

-1.9  3.4

6.2  2.9

3  2.9

-3.3  2.9

0.024

Qmax (39)

7.9  2.4

10.3  4.6

2.4  5.1

9.6  4.3

12.0  6.1

2.4  5.3

1

MSHQ-EjD

11.3  4.2

9.1  3.8

-2.1  4.2

8.9  3.6

9.9  3.7

1.0  2.9

0.003

3.3  1.7

2.4  1.7

-0.8  1.6

2.5  1.7

2.1  1.6

-0.4  1.3

0.312

16.2  7.2

17  7.2

0.8  4.3

16  6.7

16.3  8.2

0.3  4.7

0.636

Control

Crossover

Crossover

Crossover

Function (36) MSHQ-EjD Bother (36) IIEF-5 (SHIM) (36)

p-Value obtained using a paired Student’s t-test. AUASI e American Urological Association Symptom Index; QOL e AUASI Quality of Life; BPHII e BPH Impact Index; Qmax e peak urinary flow; MSHQEjDe Male Sexual Health Questionnaire for Ejaculatory Dysfunction; IIEF e International Index for Erectile Function.