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

描述(申请人提供)：良性前列腺增生症是美国男性最常见的慢性疾病之一。传统的“黄金标准”外科治疗方法是经尿道前列腺切除术(TURP)。然而，在过去的十年里，微创外科治疗(MIST程序)的使用变得越来越普遍，如经尿路微波热疗(TUMT)、激光治疗和经尿路针头消融疗法(金枪鱼)。我们最近确定，老年男性医疗保险受益人接受MIST手术的次数从1999年的17,791例增加到2005年的112,788例，增幅为634%。与此同时，在这一人群中进行的经尿道前列腺切除术(TURP)的数量减少了29%，从104,363例降至73,356例。这两种不同的趋势导致这一人群在短短6年内进行的前列腺增生症手术增加了50%以上，从1999年的128,415例增加到2005年的193,555例。 最初，这项研究将更详细地检查从1999年到2006年对65岁以上男性使用MIST程序的情况。我们将描述和比较那些接受雾化疗法的人和那些接受Turps的人的社会人口学特征，包括白人和少数群体成员之间的比率比较。然后，我们将描述在MIST手术后需要泌尿科医生护理的重要事件，包括手术后诊断测试、使用相同或另一种MIST程序或TURP的再次手术，以及手术后长达7年的其他术后治疗干预。将对不同的MIST程序以及每个MIST程序和TURP之间的这些事件的发生率进行比较。我们还将报告不同类型的BPH手术的费用，包括手术前和手术后的护理。我们将比较每一次MIST手术以及每一次MIST手术和TURP之间的这些成本，最长可达七年。我们还将计算1999至2006年间用于BPH手术的联邦医疗保险的年度总费用。最后，我们将研究在此期间泌尿外科实践中可能发生的变化。我们将比较研究期间早期(1999年)和较晚(2004年)确诊的前列腺增生症病例从诊断到手术治疗的时间。此外，使用即将推出的联邦医疗保险D部分(处方药)数据，我们将比较2006.7年度在每种手术治疗之前使用药物治疗的比率。与公共卫生相关：微创外科治疗(MIST程序)的有效性已在临床试验中得到证明；然而，其有效性和对普通人群的临床影响，以及其受欢迎程度显著提高对卫生保健系统的影响尚不清楚。需要研究传统的有效性(相对于有效性)衡量标准，如这些程序在典型执业环境中的结果、对个别病例和医疗保健支付人(如医疗保险)的费用影响、这些新程序在传统弱势群体(例如少数族裔或族裔人群)中的可获得性和可获得性，以及对泌尿外科执业模式的影响。

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.