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Uee cost effect comb

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Uee cost effect comb Uee cost effect comb Presentation Transcript

  • IS THE BANG REALLY WORTH THE BUCK? A COST EFFICACY ANALYSIS OF COMBINATION THERAPY FOR BPH
  • Medicine or Surgery?
  • 10 most prevalent diseases in men • hypertension • coronary artery disease • type 2 diabetes • enlarged prostate • osteoarthritis • gastroesophageal reflux disease • bursitis • arrythmias • cataracts • depression
  • prostate costs • total annual medical costs $400-500 • highest likelihood of a clinical event within 1 year of treatment • annual risk for AUR or surgery 19.2% • represents a therapeutic area with highest likelihood of impact
  • Population at risk • men with significant symptoms (IPSS>7) • PSA > 1.3 ng/ml • PV > 30 gms
  • cost/QALY • From PLESS and MTOPS studies • computed cost of combination therapy per “Quality-Adjusted Life Year” • <$20,000 - should adopt • $20,000 <cost>$100,000 - good • >$100,000 - not adoptable • all patients cost/QALY = $44,336 • for patients with PSA>3.2 = $35,016
  • If you discontinue alpha- blocker after 1 year... • all patients cost/QALY = $21,068 • for patients w PSA> 3.2 = $16,697
  • arguing for TURP... • nearly 90% of patients have symptom improvement within 1 year • less than 10% failure rate after 3 years • less than 4% stricture and bladder neck complications • 5 year costs • TURP = $7334 • alpha AR blocker = $6294
  • Medicines vs Surgery duration of days intervention insurance cost medicare cost response lost alpha blockers $2422 $1820 2y 8 5-ARIs $2860 $2161 2y 8 TURP $6411 $3874 2y 22
  • PHL COSTS OF MEDICINES • AVERAGE ALPHA BLOCKER = PhP 70/d • 5 ARI = PhP 50/d • PhP 120/d • PhP 3,600/mo • PhP 43,800/yr
  • PHL cost of TURP (hospitalization only) out of pocket after medicare Bicol 20-25,000 Tuguegarao 5,000 Bacolod 15-20,000 Pampanga 40,000 25,000 Cebu 50-60,000 Davao 70,000 25-30,000 Bulacan 20,000 Laguna 35-40,000 JRRMMC/FEU 30-35,000 20-25,000 Philippine General Hosp 40-50,000 Manila Doctors Hosp 60-75,000 SLMC Global City 120,000-130,000
  • how much is your PF?
  • combat: asian sub-analysis Country Patients Korea 117 Philippines 74 Taiwan 70 Thailand 24 Canada 17 South Africa 3 UK 1 USA 19
  • Total population: Mean change in IPSS from baseline
  • Asian subgroup: Mean change in IPSS from baseline
  • Asian subgroup: Mean change in Qmax from baseline
  • thank you