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Cost-effectiveness of alternative first- and second-line treatments for benign prostatic hyperplasia in Singapore.

Publication ,  Journal Article
Chay, J; Tung, JYM; Su, RJ; Aslim, EJ; Wong, C; Swan, G; Chua, WJ; Ho, HSS; Finkelstein, EA
Published in: J Med Econ
2023

BACKGROUND: Minimally invasive surgical therapies, such as water vapor thermal therapy (WVTT) and prostatic urethral lift (PUL), are typically second-line options for patients in whom medical management (MM) failed but who are unwilling or unsuitable to undergo invasive transurethral resection of the prostate (TURP). However, the incremental cost-effectiveness of WVTT or PUL as first- or second-line therapy is unknown. We evaluated the incremental cost-effectiveness of alternative first- and second-line treatments for patients with moderate-to-severe benign prostatic hyperplasia (BPH) in Singapore to help policymakers make subsidy decisions based on value for money. METHODS: We considered six stepped-up treatment strategies, beginning with MM, WVTT, PUL or TURP. In each strategy, patients requiring retreatment advance to a more invasive treatment until TURP, which may be undergone twice. A Markov cohort model was used to simulate transitions between BPH severity states and retreatment, accruing costs and quality-adjusted life-years (QALYs) over a lifetime horizon. RESULTS: In moderate patients, strategies beginning with MM had similar cost and effectiveness, and first-line WVTT was incrementally cost-effective to first-line MM (33,307 SGD/QALY). First-line TURP was not incrementally cost-effective to first-line WVTT (159,361 SGD/QALY). For severe patients, WVTT was incrementally cost-effective to MM as a first-line treatment (30,133 SGD/QALY) and to TURP as a second-line treatment following MM (6877 SGD/QALY). TURP was incrementally cost-effective to WVTT as a first-line treatment (48,209 SGD/QALY) in severe patients only. All pathways involving PUL were dominated (higher costs and lower QALYs). CONCLUSION: Based on the common willingness-to-pay threshold of SGD 50,000/QALY, this study demonstrates the cost-effectiveness of WVTT over MM as first-line treatment for patients with moderate or severe BPH, suggesting it represents good value for money and should be considered for subsidy. PUL is not cost-effective as a first- nor second-line treatment. For patients with severe BPH, TURP as first-line is also cost-effective.

Duke Scholars

Published In

J Med Econ

DOI

EISSN

1941-837X

Publication Date

2023

Volume

26

Issue

1

Start / End Page

1269 / 1277

Location

England

Related Subject Headings

  • Treatment Outcome
  • Transurethral Resection of Prostate
  • Singapore
  • Prostatic Hyperplasia
  • Minimally Invasive Surgical Procedures
  • Male
  • Humans
  • Health Policy & Services
  • Cost-Benefit Analysis
  • 4202 Epidemiology
 

Citation

APA
Chicago
ICMJE
MLA
NLM
Chay, J., Tung, J. Y. M., Su, R. J., Aslim, E. J., Wong, C., Swan, G., … Finkelstein, E. A. (2023). Cost-effectiveness of alternative first- and second-line treatments for benign prostatic hyperplasia in Singapore. J Med Econ, 26(1), 1269–1277. https://doi.org/10.1080/13696998.2023.2266958
Chay, Junxing, Joshua Yi Min Tung, Rebecca Jade Su, Edwin Jonathan Aslim, Callix Wong, Georgia Swan, Wei Jin Chua, Henry Sun Sien Ho, and Eric Andrew Finkelstein. “Cost-effectiveness of alternative first- and second-line treatments for benign prostatic hyperplasia in Singapore.J Med Econ 26, no. 1 (2023): 1269–77. https://doi.org/10.1080/13696998.2023.2266958.
Chay J, Tung JYM, Su RJ, Aslim EJ, Wong C, Swan G, et al. Cost-effectiveness of alternative first- and second-line treatments for benign prostatic hyperplasia in Singapore. J Med Econ. 2023;26(1):1269–77.
Chay, Junxing, et al. “Cost-effectiveness of alternative first- and second-line treatments for benign prostatic hyperplasia in Singapore.J Med Econ, vol. 26, no. 1, 2023, pp. 1269–77. Pubmed, doi:10.1080/13696998.2023.2266958.
Chay J, Tung JYM, Su RJ, Aslim EJ, Wong C, Swan G, Chua WJ, Ho HSS, Finkelstein EA. Cost-effectiveness of alternative first- and second-line treatments for benign prostatic hyperplasia in Singapore. J Med Econ. 2023;26(1):1269–1277.

Published In

J Med Econ

DOI

EISSN

1941-837X

Publication Date

2023

Volume

26

Issue

1

Start / End Page

1269 / 1277

Location

England

Related Subject Headings

  • Treatment Outcome
  • Transurethral Resection of Prostate
  • Singapore
  • Prostatic Hyperplasia
  • Minimally Invasive Surgical Procedures
  • Male
  • Humans
  • Health Policy & Services
  • Cost-Benefit Analysis
  • 4202 Epidemiology