Measuring the Impact of the Rapid Expansion of MIST Procedures for BPH

衡量 MIST 手术快速扩展对 BPH 的影响

• 批准号: 7918095
• 负责人: ALEXANDER M MCBEAN
• 金额: $ 18.88万
• 依托单位: UNIVERSITY OF MINNESOTA
• 依托单位国家: 美国
• 财政年份: 2009
• 资助国家: 美国
• 起止时间: 2009-09-01 至 2012-02-29
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/7918095
• 关键词: Ablation; Age-Years; Americas; Asians; Benign Prostatic Hypertrophy; Caring; Censuses; Characteristics; Chronic; Clinical Trials; Clinical effectiveness; Data; Diagnosis; Diagnostic; Diagnostic tests; Diffusion; Disadvantaged; Drug Prescriptions; Early Diagnosis; Effectiveness; Elderly; Enrollment; Ethnic Origin; Event; General Population; Goals; Gold; Health; Healthcare; Healthcare Systems; Healthy People 2010; Hispanics; Hospitals; Individual; Low-Level Laser Therapy; Measures; Medical; Medicare; Minority; Minority Groups; Monitor; NIH Program Announcements; Needles; Operative Surgical Procedures; Outcome; Outpatients; Patients; Pattern; Physicians; Population; Population Decreases; Postoperative Period; Prior Therapy; Procedures; Prostatectomy; Provider; Race; Reporting; Testing; Therapeutic; Therapeutic Intervention; Time; Transurethral Thermotherapy; United States Centers for Medicare and Medicaid Services; Urologist; Urology; base; beneficiary; cost; effectiveness measure; health disparity; male; member; men; minimally invasive; operation; prostate transurethral resection; public health relevance; trend; urinary; urologic

DESCRIPTION (provided by applicant): Benign prostatic hyperplasia is one of the most common chronic conditions among America men. The traditional, `gold standard', surgical treatment is transuretheral prostatectomy (TURP). However, during the last decade the use of minimally invasive surgical treatments (MIST procedures) such as transurethral microwave thermotherapy (TUMT), laser therapy, and transurethral needle ablation therapy (TUNA) have become increasingly common. We have recently determined that the number of MIST procedures performed in elderly male Medicare beneficiaries increased from 17,791 in 1999 to 112,788 in 2005, a 634% increase. Concurrently, the number of transurethral prostatectomies (TURPs) performed in this population decreased by 29% from 104,363 to 73,356. These two different trends have resulted in over a 50% increase in surgeries performed for BPH in this population in just 6 years, form 128,415 in 1999 to 193,555 in 2005. Initially, this study will examine the use of the MIST procedures from 1999 through 2006 for men 65+ years of age in more detail. We will describe and compare the socio-demographic characteristics of those receiving MIST therapy compared with those who receive TURPs, including a comparing the rates between Whites and minority group members. We will then describe important events requiring care by a urologist following the MIST procedures including post-operative diagnostic tests, re-operations with the same or another MIST procedure or TURP, and other post-operative therapeutic interventions for up to 7 years following the surgeries. Comparisons of the rates of these events following different MIST procedures will be made, as well as between each MIST procedure and TURP. We will also report the costs of different types of BPH surgery, including pre- and post-operative care. We will compare these costs between each MIST procedure, as well as between each MIST procedure and TURP for up to seven years post BPH surgery. We will also calculate the total annual costs to Medicare for BPH surgery for the years 1999 through 2006. Finally, we will examine possible changes in urologic practice during this period. We will compare the time from the diagnosis of BPH to surgical treatment for incident cases of BPH diagnosed early (1999) and later (2004) in the study period. Also, using the soon to be available Medicare Part D (prescription drug) data, we will compare the rates of use of medical therapy prior to each type of surgical treatment in 2006.7. PUBLIC HEALTH RELEVANCE: The efficacy of minimally invasive surgical treatments (MIST procedures) has been demonstrated in clinical trials; however, their effectiveness and clinical impact in the general population, as well as the impact of their remarkable increase in popularity on the health care system, are not known. Traditional measures of effectiveness (as opposed to efficacy) such as the outcomes of these procedures in typical practice settings, the cost implications for individual cases and health care payers such as Medicare, their availability and access to (as measured by utilization) these new procedures among traditionally disadvantaged populations (those of minority race or ethnicity, for example), and the effects on the practice patterns in urology need to be studied.

描述（由申请人提供）：良性前列腺增生是美国男性中最常见的慢性疾病之一。传统的“黄金标准”手术治疗是经尿道前列腺切除术（TURP）。然而，在过去的十年中，微创手术治疗（MIST手术），如经尿道微波热疗（TUMT），激光治疗和经尿道针消融治疗（TUNA）的使用已经变得越来越普遍。我们最近确定，在老年男性医疗保险受益人中进行的MIST程序数量从1999年的17，791增加到2005年的112，788，增加了634%。同时，在这一人群中进行的经尿道前列腺切除术（TURP）的数量从104，363例下降到73，356例，下降了29%。这两种不同的趋势导致在短短6年内，该人群中BPH手术增加了50%以上，从1999年的128，415例增加到2005年的193，555例。 最初，本研究将更详细地检查1999年至2006年65岁以上男性使用MIST手术的情况。我们将描述和比较接受MIST治疗的人与接受TURP的人的社会人口学特征，包括比较白人和少数民族成员之间的比率。然后，我们将描述MIST手术后需要泌尿科医生护理的重要事件，包括术后诊断测试，相同或另一种MIST手术或TURP的再次手术，以及手术后长达7年的其他术后治疗干预。将比较不同MIST手术后这些事件的发生率，以及每种MIST手术与TURP之间的发生率。我们还将报告不同类型的BPH手术的费用，包括术前和术后护理。我们将比较每个MIST手术之间的这些成本，以及每个MIST手术与BPH手术后长达七年的TURP之间的成本。我们还将计算1999年至2006年BPH手术的医疗保险年度总费用。最后，我们将探讨在此期间泌尿外科实践的可能变化。我们将比较研究期间早期（1999年）和晚期（2004年）诊断的BPH病例从诊断到手术治疗的时间。此外，使用即将可用的医疗保险D部分（处方药）数据，我们将比较2006年每种手术治疗前药物治疗的使用率。公共卫生相关性：微创手术治疗（MIST手术）的疗效已在临床试验中得到证实;然而，其在一般人群中的有效性和临床影响，以及其显著增加的普及对医疗保健系统的影响尚不清楚。传统的有效性措施（与疗效相反），例如这些程序在典型实践环境中的结果，对个别病例和医疗保健支付者（如Medicare）的成本影响，其可用性和获得（按使用情况衡量）这些新程序在传统上处于不利地位的人口中的使用情况（例如，少数民族），以及对泌尿外科实践模式的影响需要研究。