Sanderson C F, Hunter D J, McKee C M, Black N A
Health Services Research Unit, London School of Hygiene and Tropical Medicine, UK.
Med Care. 1997 Jul;35(7):669-85. doi: 10.1097/00005650-199707000-00002.
The aim of this study was to make epidemiologically based estimates of the prevalent and incident "need" for prostatectomy for lower urinary tract symptoms, defined as the numbers of men who would both benefit from and want the operation.
The methods involved a consensus panel, a two-stage postal survey of 1,480 men aged 55 years or older from eight general practices to the northwest of London, United Kingdom, and a multistate life table.
The overall response rate was 69% (initial survey: 78%, follow-up survey: 88%). A trial-based estimate of number of candidates for prostatectomy (men with symptoms that were at least moderately severe and bothersome and who would probably or definitely want surgery) was 610 men in a population of 250,000. The corresponding incidence estimate (including men with symptoms recurring after spontaneous remission or surgery) was approximately 200 per year, including approximately 110 new cases. Consensus-based estimation, including categories of patients who have not yet been subject to a trial, gave much higher figures of approximately 3,000, 650, and 200 candidates, respectively. Adding the number of men who said they were "inclined to" choose surgery would almost double these figures.
Estimates of need were highly sensitive to choice of indications and assumptions about patients' attitudes toward surgery. Population needs assessment for specific procedures will always involve judgment as well as epidemiological data and modeling.
本研究旨在基于流行病学对因下尿路症状而进行前列腺切除术的现患需求和新发需求进行估计，该需求定义为既将从手术中获益又希望接受手术的男性人数。
研究方法包括一个共识小组、对来自英国伦敦西北部八个普通诊所的1480名55岁及以上男性进行两阶段邮寄调查，以及一个多状态生命表。
总体回复率为69%（初始调查：78%，随访调查：88%）。基于试验对前列腺切除术候选人数（症状至少为中度严重且令人困扰、可能或肯定希望接受手术的男性）的估计是，在25万人口中有610名男性。相应的发病率估计（包括自发缓解或手术后症状复发的男性）约为每年200例，其中包括约110例新病例。基于共识的估计，包括尚未接受试验的患者类别，分别给出了高得多的数字，约为3000名、650名和200名候选者。加上表示“倾向于”选择手术的男性人数，这些数字几乎会翻倍。
需求估计对适应症的选择以及对患者手术态度的假设高度敏感。针对特定手术的人群需求评估总是需要判断以及流行病学数据和建模。
