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INTRODUCTION: Benign Prostate Hyperplasia (BPH) significantly impacts men's health and quality of life, with its prevalence rising with age. This review critically examines the cost-effectiveness of pharmacological interventions for BPH to optimize patient outcomes and healthcare resource utilization. AREAS COVERED: This review explores the integration of cost-effectiveness analysis (CEA) into clinical practice, balancing clinical efficacy with economic efficiency in BPH management. We performed a critical literature search, including recent studies on the economic evaluation of BPH treatments, focusing on pharmacotherapies such as alpha-blockers and 5-alpha reductase inhibitors. Additionally, we discussed the concept of CEA and evaluated the role of medicinal reconciliation and the avoidance of polypharmacy in favor of optimal BPH treatment. EXPERT OPINION: Cost-effectiveness analysis is crucial for evaluating BPH treatments, with evidence suggesting a shift towards surgical interventions may offer greater long-term economic benefits. However, these models must be applied cautiously, considering clinical evidence and patient preferences to ensure equitable and patient-centric healthcare.
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Inibidores de 5-alfa Redutase , Antagonistas Adrenérgicos alfa , Análise Custo-Benefício , Hiperplasia Prostática , Qualidade de Vida , Humanos , Hiperplasia Prostática/tratamento farmacológico , Hiperplasia Prostática/economia , Masculino , Inibidores de 5-alfa Redutase/uso terapêutico , Inibidores de 5-alfa Redutase/economia , Antagonistas Adrenérgicos alfa/uso terapêutico , Antagonistas Adrenérgicos alfa/economia , Preferência do Paciente , Análise de Custo-EfetividadeRESUMO
INTRODUCTION: Prostate cancer is one of the most common neoplasms in men. For many years the mainstay of treatment was androgen deprivation therapy, but during last decade many novel agents have emerged, accompanied by increased costs for healthcare systems. AREAS COVERED: In this literature review, the authors provide a pharmacoeconomic review of several pharmaceutical agents used in several disease stages, by summarizing evidence from cost-analysis, cost-effectiveness, cost-utility, cost-saving, cost-benefit and budgetary impact analysis studies. EXPERT OPINION: The rapid development of therapeutic agents for prostate cancer has put a great budgetary burden on healthcare systems, since these drugs are prolonging survival and improving quality of life . Since existing data are now mature enough from a number of clinical trials with long-term follow-up, policy makers should propose not only the most clinically effective but also the most cost-effective agents, in order for every patient to gain access at least to some of these therapies. Docetaxel addition seems to be a cost-effective option, when compared to both abiraterone and enzalutamide (due to costs related to acquisition and side effects). Cabazitaxel is a strong candidate after docetaxel failure, while both denosumab and bisphosphonates are cost-effective for reducing skeletal-related events in metastatic disease.
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Antineoplásicos , Preparações Farmacêuticas , Neoplasias de Próstata Resistentes à Castração , Antagonistas de Androgênios/uso terapêutico , Antineoplásicos/uso terapêutico , Farmacoeconomia , Humanos , Masculino , Neoplasias de Próstata Resistentes à Castração/tratamento farmacológico , Qualidade de VidaRESUMO
Background:Metastatic RCC (mRCC) treatment has been revolutionized with 11 approved targeted agents. We report patterns of practice, outcomes and pharmacoeconomic analyses after the introduction of targeted therapy. Patients and methods: CRISIS was a retrospective multicenter study of mRCCpatients who received targeted therapy . Results were related to the start of 1st-line therapy, with a cut off at 1 January 2011 in order to depict the impact of increased availability of effective options. Results: 164 patients, were included. 70.1% and 44.5% received 2nd and 3rd-line therapy, respectively. More patients were treated in 2nd-line after 1 January 2011. After a median follow-up of 55.1 months, median progression-free (PFS) and overall survival (OS) were 10.7 (95% confidence intervals [CI]: 8.3-13.7), 7.3 (95% CI: 5.1-8.6), 5.8 (95% CI: 3.8-7.8) and 34 (95% CI: 28.5-39.8), 22.4 (95% CI: 16-32.1), 18.3 (95% CI: 12.4-26.4) months for first, second and third line, respectively. Efficacy of sunitinib and pazopanib in 1st-line were similar. The mean total cost/patient was 35,012.2 Euros (standard deviation [SD]: 28,971.5). Conclusions: Our study confirms previous real-world data suggesting that continuing advances in the treatment of mRCC produce favorable outcomes in everyday practice. Pharmacoeconomic analyses are important for cost-effective utilization of emerging novel therapies.
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Carcinoma de Células Renais/tratamento farmacológico , Farmacoeconomia , Neoplasias Renais/tratamento farmacológico , Terapia de Alvo Molecular/métodos , Adulto , Idoso , Idoso de 80 Anos ou mais , Antineoplásicos/administração & dosagem , Antineoplásicos/economia , Carcinoma de Células Renais/economia , Análise Custo-Benefício , Intervalo Livre de Doença , Feminino , Seguimentos , Grécia , Humanos , Indazóis , Neoplasias Renais/economia , Masculino , Pessoa de Meia-Idade , Terapia de Alvo Molecular/economia , Metástase Neoplásica , Padrões de Prática Médica/estatística & dados numéricos , Pirimidinas/administração & dosagem , Pirimidinas/economia , Estudos Retrospectivos , Sulfonamidas/administração & dosagem , Sulfonamidas/economia , Sunitinibe/administração & dosagem , Sunitinibe/economia , Taxa de SobrevidaRESUMO
Background: Simulation-based technical skill assessment is a core topic of debate, especially in high-risk environments. After the introduction of the E-BLUS (European Basic Laparoscopic Urological Skills) exam for basic laparoscopy, no more technical training/assessment urological protocols have been developed in Europe. Objective: We describe the methodology used in the development of the novel Endoscopic Stone Treatment step 1 (EST s1) assessment curriculum. Materials and Methods: The "full life cycle curriculum development" template was followed for curriculum development. A cognitive task analysis was run to define the most important steps and details of retrograde intrarenal surgery, in accordance with European Association of Urology (EAU) Urolithiasis guidelines. Training tasks were created between April 2015 and September 2015. Tasks and metrics were further analyzed by a consensus meeting with the European Section of Urolithiasis (EULIS) board in February 2016. A review, aimed to study available simulators and their accordance with task requirements, was subsequently run in London in March 2016. After initial feedback and further tests, content validity of this protocol was achieved during European Urology Residents Education Programme (EUREP) 2016. Results: The EST s1 curriculum development, took 23 months. Seventy-two participants tested the five preliminary tasks during EUREP 2015, with sessions of 45 minutes each. Likert-scale questionnaires were filled out to score the quality of training. The protocol was modified accordingly and 25 participants tested the four tasks during the hands-on training sessions of the European Section of Uro-Technology (ESUT) 2016 congress. One hundred thirty-four participants finally participated in the validation study in EUREP 2016. During the same event, 10 experts confirmed content validity by filling out a Likert-scale questionnaire. Conclusion: We described a reliable and replicable methodology that can be followed to develop training/assessment protocols for surgical procedures. The expert consensus meetings, strict adherence to guidelines, and updated literature search toward an Endourology curriculum allowed correct training and assessment protocol development. It is the first step toward standardized simulation training in Endourology with a potential for worldwide adoption.
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INTRODUCTION: The aim of this review was to identify trends and developments in basic research, epidemiology, diagnosis, conservative and surgical management of urinary stone disease, and to demonstrate the evolution of urolithiasis management in the new millennium. EVIDENCE ACQUISITION: We performed a literature search on Medline according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) statement up to December 2015 using the following key words: urolithiasis prevalence, recurrent urinary stone, metabolic syndrome and urolithiasis, urinary stone/urolithiasis metabolic evaluation, shockwave lithotripsy, ureterorenoscopy, percutaneous nephrolithotomy/nephrolitholapaxy. The key words were chosen following consensus as the single most appropriate and descriptive terms that would yield maximal relevant results in a single search for each section. We then segregated only relevant articles in the English language of the highest quality evidence (systematic review/meta-analysis, prospective cohorts and prospective randomized trials, levels of evidence: 1A and 1B, respectively) as well as experimental research. The initial relevance screening was based on title and abstract, whereas further filtering included full text screening. The evidence is subsequently presented and discussed on each relevant section, preceded by seminal references that are used as a basis for comparison to formulate our conclusions. EVIDENCE SYNTHESIS: By using the key word "urolithiasis prevalence" we identified initially 1581 relevant articles. Following exclusion of duplicates and relevance screening, 154 articles were included for data extraction (9.77%). Of note, 31 articles focused on the pediatric population. By using the key words "metabolic syndrome and urolithiasis" we identified initially 127 relevant articles. Following exclusion of duplicates and relevance screening, 23 articles were included for data extraction (18.11%). It must be noted that the majority of studies are reviews, experimental models and prospective cohorts. By using the key words "urolithiasis metabolic evaluation" we identified initially 262 relevant articles. Following exclusion of duplicates and relevance screening, 179 articles were included for data extraction (68.32%). It must be noted that the majority of studies are reviews, experimental models and prospective cohorts. By using the key word "shockwave lithotripsy" we identified initially 695 relevant articles. Following exclusion of duplicates and relevance screening, 90 articles were included for data extraction (12.94%). By using the key word "ureterorenoscopy" we identified initially 2609 relevant articles. Following exclusion of duplicates and relevance screening, 186 articles were included for data extraction (7.12%). By using the key word "percutaneous nephrolithotomy" we identified initially 695 relevant articles. Following exclusion of duplicates and relevance screening, 381 articles were included for data extraction (10.42%). CONCLUSIONS: The management of urolithiasis has evolved greatly and in multiple directions in the past fifteen years. There is a definite compartmentalization of basic research, innovation and development focusing on distinct stages of the disease, from epidemiologic features to pathophysiology, medical and surgical aspects. Patients enjoy better delivery of care, having ever more effective options to deal with their condition. The multidisciplinary approach provides more reliable solutions and will continue to drive the development of better preventative and treatment strategies in the future.
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Urolitíase/diagnóstico , Urolitíase/terapia , Humanos , Histeroscopia , Laparoscopia , Litotripsia , Nefrostomia Percutânea , Urolitíase/epidemiologia , Urolitíase/metabolismoRESUMO
Fortunately, novel agents are nowadays available for the management of patients with castration-resistant prostate cancer (CRPC). Denosumab is a new bone-protective agent, approved for the prevention and management of skeletal-related events. Studies have demonstrated that denosumab has better efficacy and similar rate of adverse effects in comparison with zoledronic acid, which was the standard bone-protective agent. In the present review we study the cost-effectiveness of denosumab in patients with CRPC.
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Neoplasias Ósseas/prevenção & controle , Denosumab/uso terapêutico , Neoplasias de Próstata Resistentes à Castração/patologia , Conservadores da Densidade Óssea/economia , Conservadores da Densidade Óssea/uso terapêutico , Neoplasias Ósseas/secundário , Análise Custo-Benefício , Denosumab/economia , Difosfonatos/economia , Difosfonatos/uso terapêutico , Humanos , Imidazóis/economia , Imidazóis/uso terapêutico , Masculino , Ácido ZoledrônicoRESUMO
Abiraterone acetate is an oral medication that has recently been granted approval for the treatment of metastatic castration resistant prostate cancer (mCRPC) prior and/or after chemotherapy with docetaxel. In this article we assess the economics of abiraterone acetate in mCRPC. Relevant studies demonstrated that abiraterone acetate had a minimal budget impact on health plans. A relevant advantage was the cost savings due to the lack of chemotherapy-related side effects as well as the ease of administration. The results of cost/benefit comparative studies with other novel agents (i.e. cabazitaxel, enzalutamide, sipuleucel-T) are warranted as well as the close collaboration between urologists and medical oncologists.