Department of Urology, Ajou University School of Medicine, Suwon, South Korea.
BJU Int. 2019 May;123(5A):E79-E85. doi: 10.1111/bju.14584. Epub 2018 Nov 2.
To analyse actual long-term medical treatment of benign prostatic hyperplasia (BPH) and compare the incurred cost with that of patients with BPH who underwent early surgery.
Patients who were first diagnosed with BPH from 1 January 2008 to 31 December 2010 were identified using the Clinical Data Warehouse. Hospital billing data generated by the electronic hospital management system were collected until December 2015. For outpatient care, only procedures, materials and drugs directly related to the management of BPH were selected for the analysis. For inpatient care, all procedures, materials and drugs ordered on dates with continuity with BPH surgery date were included. The primary endpoint of the study was the total treatment-related direct costs of patients undergoing a long-term curative medical therapy for BPH (Group 1), which was arbitrarily defined as any medical therapy including a 5α-reductase inhibitor with a minimum medication possession ratio of 0.5 during ≥5 consecutive years, or ≥1 year until BPH surgery due to medical therapy failure. In all, 70 patients who underwent BPH surgery at <1 year of initial visit served as controls (Group 2).
Amongst 137 patients in the Group 1, four patients underwent BPH surgery at a median of 57.8 months after the initial visit (2.9%). At a median follow-up of 76 months, the mean total treatment cost was significantly higher in Group 1 than in Group 2 ($3987 vs $3036 [USA dollars], P < 0.001). Similarly, the mean 'out-of-pocket' cost was significantly higher in Group 1 than in Group 2 ($1742 vs $1436, P = 0.005). When a linear increment of annual BPH treatment cost is assumed for Group 1 and all costs are assumed to be produced within the first year for Group 2, the total and out-of-pocket costs became equal at the end of the fifth year of medical treatment. For both total and out-of-pocket costs, medication-related costs occupied the largest proportion, exceeding half of the costs.
We suggest patient counselling at the beginning of BPH treatment should include the likelihood that the cumulative out-of-pocket cost at 5 years of continuous medication will exceed that of early surgery. Our cost study using hospital billing data extractable from the electronic hospital management system may be a good model for cost studies that could provide valuable information to health providers and payers.
分析良性前列腺增生症（BPH）的实际长期治疗情况，并将其与早期手术患者的治疗费用进行比较。
使用临床数据仓库，确定 2008 年 1 月 1 日至 2010 年 12 月 31 日期间首次被诊断为 BPH 的患者。从电子医院管理系统生成的医院计费数据中收集了截至 2015 年 12 月的信息。对于门诊护理，仅选择与 BPH 管理直接相关的程序、材料和药物进行分析。对于住院护理，包括与 BPH 手术日期具有连续性的日期内所有开列的程序、材料和药物。本研究的主要终点是接受 BPH 长期治疗的患者的总治疗相关直接费用（第 1 组），这是任意定义的，包括至少 5 年连续服用 5α-还原酶抑制剂，且药物维持率至少为 0.5，或由于治疗失败而在首次就诊后 1 年内进行至少 1 年的 BPH 手术。共有 70 名在首次就诊后 <1 年内接受 BPH 手术的患者作为对照组（第 2 组）。
在第 1 组的 137 名患者中，4 名患者在首次就诊后中位数为 57.8 个月（2.9%）时接受了 BPH 手术。在中位数为 76 个月的随访中，第 1 组的平均总治疗费用明显高于第 2 组（3987 美元比 3036 美元[美元]，P<0.001）。同样，第 1 组的平均“自付”费用也明显高于第 2 组（1742 美元比 1436 美元，P=0.005）。假设第 1 组的 BPH 治疗年度成本呈线性递增，并且假设第 2 组的所有成本都在第一年产生，则第 1 组和第 2 组的总自付成本在医疗治疗的第五年末达到相等。对于总费用和自付费用，药物相关费用占比最大，超过一半的费用。
我们建议在开始 BPH 治疗时向患者提供咨询，告知他们持续服药 5 年的累计自付费用可能超过早期手术的费用。我们使用可从电子医院管理系统中提取的医院计费数据进行的成本研究可能是成本研究的良好模型，可为医疗服务提供者和支付方提供有价值的信息。
