Research type:
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Secondary Research (e.g. systematic review)
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Project title:
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Systematic review and economic modelling of effectiveness and cost utility of surgical treatments for men with benign prostatic enlargement (BPE) |
Project ref: |
04/38/03 |
Cost: |
£108,410 |
Chief Investigator : |
Professor James Michael Olu N'Dow, Professor of Urology,
Academic Urology Unit, University of Aberdeen
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Start Date: |
July 2005. |
Publication date: |
October 2008. This project is at the editorial review stage. Delays in the review process can cause the forecast publication date to be delayed.
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Plain English Summary |
Benign enlargement of the prostate (BPE) is a common cause of difficulties in urination in older men affecting up to 40% of those older than 70 years. These symptoms result in disruption of day-to-day life leading men to seek medical advice. In the past, treatment options were limited to either open removal of the prostate or coring out of the prostate through the urine tube (urethra) using telescopic electrosurgery, so-called trans-urethral resection of the prostate (TURP). Today TURP is the standard procedure since it provides long lasting symptom relief. It does however have some disadvantages including the need for a general anaesthetic, a stay in hospital, and some unwanted effects. Because of these disadvantages less invasive procedures for reducing the size of the prostate using alternative energy sources (such as ultrasound) have been developed. These often do not require a general anaesthetic, can be carried out in an out-patient setting, and tend to have fewer unwanted effects. Uncertainty remains as to their effectiveness, making it difficult for patients, clinicians and health care providers to decide their place in the treatment of men suffering from BPE. The aim of this research is to clarify these uncertainties and produce a balance sheet, ranking the alternative procedures against TURP in terms of benefits, risks, and 'value for money'. Evidence from previously conducted studies will be found by systematically searching the research literature, collating the results in a standard format and then synthesised. The differing effects identified will be related to the resources used (such as time in hospital, and need for further treatment) and compared using health economics methods. We hope to identify which patients are best suited to particular types of treatment and where we cannot, to identify areas where future research is required. The research project team is a multidisciplinary partnership between experienced teams in Aberdeen and Newcastle, involving clinical urologists, health services researchers and health economists, collaborating with consumers and the Cochrane Collaboration. The costs requested are for reviewers, economist, and for meetings, teleconferences, two computers and stationery.
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Abstract: |
The planned research addresses the commissioning brief closely. Established and emerging interventional treatments for BPE will be considered. In addition to the four procedures stated in the brief (TUVP, TUNA, holmium laser resection, KTP laser vaporisation, with TURP as comparator), we propose to assess a further seven interventions (TUIP, Plasma-kinetic bipolar electrovaporisation, HIFU, Transurethral ethanol injection, water thermotherapy, TUMT and prostatic stents). The choice has been based on procedures mentioned in current clinical guidelines, procedures considered by NICE's Interventional Procedures Programme, and clinical judgement. In partnership with consumer representatives and the Cochrane Prostatic Diseases Group, a multidisciplinary team will undertake a systematic review with economic modelling of the effects of the procedures, taking a long-term perspective. In addition, the report will recommend where further research would likely be most profitable, describe the speed of development in the field to guide timing of updates of the work, and comment on the implications of differences between procedures in surgical skill and learning.
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MeSH* index primary terms: |
PROSTATIC-HYPERPLASIA Q-economics; PROSTATIC-HYPERPLASIA Q-surgery |
MeSH* index secondary terms: |
HUMANS; REVIEW; MALE |
NRR* number, if applicable: |
N0484166957 (*National Research Register) |
Project Protocol: |
Project protocol not available
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URL of this page: |
http://www.hta.ac.uk/1468 |
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