Discounting surgical benefits. Enucleation versus resection of the prostate.

This manuscript introduces and demonstrates a modification of the popular cost-effectiveness methodology. Because arbitrarily selected discount rates for future health effects can radically change the cost-effect ratio, the determinants of the ratio--differences in the present values of effects and costs-are examined for a wide range of discount rates. Treatment selection then follows directly from explicit judgments about expected patient longevity and appropriate combinations of cost and effect discount rates. The decision to select resection or enucleation of a benign prostatic hypertrophy is developed with data from a small number of clinical patients from Washington University.