An early analysis of the cost-effectiveness of a diagnostic classifier for risk stratification of haematuria patients (DCRSHP) compared to flexible cystoscopy in the diagnosis of bladder cancer.

BACKGROUND: Urothelial bladder cancer (UBC) is the 5th most common cancer in Western societies. The most common symptom of UBC is haematuria. Cystoscopy the gold standard for UBC detection, allows direct observation of the bladder, but is expensive, invasive, and uncomfortable. This study examines whether an alternative new urine-based diagnostic test, the DCRSHP, is cost-effective as a triage diagnostic tool compared to flexible cystoscopy in the diagnosis of UBC in haematuria patients. METHODS: A model-based cost-utility analysis using cost per quality adjusted life year and life year gained, parameterised with secondary data sources. RESULTS: If the DCRSHP is targeted at haematuria patients at lower risk of having bladder cancer e.g. younger patients, non-smokers, then it can be priced as high as £620, and be both effective and cost-effective. Sensitivity analysis found that DCRSHP is approximately 80% likely to be cost-effective across all willingness to pay values (for a QALY) and prevalence estimates. CONCLUSION: This analysis shows the potential for a non-invasive test to be added to the diagnostic pathway for haematuria patients suspected of having UBC. If the DCRSHP is applied targeting haematuria patients at low risk of UBC, then it has the potential to be both effective and cost-effective.

A comparison of the frequencies of medical therapies for overactive bladder in men and women: analysis of more than 7.2 million aging patients.

BACKGROUND: The study of overactive bladder (OAB) symptoms has historically focused on women. However, it is now evident that men, including those with benign prostatic hyperplasia, have OAB symptoms that respond to anticholinergic therapy. The current OAB treatment frequencies by gender are unknown. OBJECTIVE: The aim of the study was to compare the treatment patterns among men and women diagnosed with OAB. DESIGN, SETTING, AND PARTICIPANTS: Patients ≥45 yr in the IMS Health data set with more than one diagnosis code for OAB during a 12-mo period ending December 2007. INTERVENTION: Treated patients filled a prescription for either an anticholinergic or a tricyclic antidepressant medication; untreated patients did not. MEASUREMENTS: Frequencies of OAB diagnoses and medical therapies by age and gender were compared. RESULTS AND LIMITATIONS: Of the 7,244,501 patients ≥45yr with an OAB diagnosis, 24.4% of these were treated; 75.6% went untreated. Only 25.6% of those treated were men. The diagnosis and treatment frequency increased in both men and women as a function of age. However, in every age group, there was a significantly (p<0.001) decreased proportion of men treated compared with women. CONCLUSIONS: Despite OAB prevalence, many patients receive no medical treatment. Although the usefulness of OAB medications in men is becoming increasingly recognized, men are significantly less likely to be treated with OAB medications than women.