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

衡量 MIST 手术快速扩展对 BPH 的影响

基本信息

批准号：
7918095
负责人：
ALEXANDER M MCBEAN
金额：
$ 18.88万
依托单位：
UNIVERSITY OF MINNESOTA
依托单位国家：
美国
项目类别：
财政年份：
2009
资助国家：
美国
起止时间：
2009-09-01 至 2012-02-29
项目状态：
已结题

来源：
https://reporter.nih.gov/project-details/7918095
关键词：
Ablation Age-Years Americas Asians Benign Prostatic Hypertrophy Caring Censuses Characteristics Chronic Clinical Trials Clinical effectiveness Data Diagnosis Diagnostic Diagnostic tests Diffusion Disadvantaged Drug Prescriptions Early Diagnosis Effectiveness Elderly Enrollment Ethnic Origin Event General Population Goals Gold Health Healthcare Healthcare Systems Healthy People 2010 Hispanics Hospitals Individual Low-Level Laser Therapy Measures Medical Medicare Minority Minority Groups Monitor NIH Program Announcements Needles Operative Surgical Procedures Outcome Outpatients Patients Pattern Physicians Population Population Decreases Postoperative Period Prior Therapy Procedures Prostatectomy Provider Race Reporting Testing Therapeutic Therapeutic Intervention Time Transurethral Thermotherapy United States Centers for Medicare and Medicaid Services Urologist Urology base beneficiary cost effectiveness measure health disparity male member men minimally invasive operation prostate transurethral resection public health relevance trend urinary urologic

项目摘要

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.

描述（由申请人提供）：良性前列腺增生是美国男性最常见的慢性病之一。传统的“金标准”手术治疗是经术前列腺切除术（TURP）。然而，在过去的十年中，使用微创手术治疗（雾性手术），例如尿道尿道微波热疗（TUMT），激光治疗和尿道尿素消融疗法（金枪鱼）已经变得越来越普遍。我们最近确定，在老年男性医疗保险受益人中执行的雾气次数从1999年的17,791增加到2005年的112,788，增加了634％。同时，该人群中进行的尿道前列腺切除术（TURP）的数量从104,363降至73,356。这两种不同的趋势导致该人群中BPH进行的手术增加了50％以上，在1999年的128,415次，到2005年的193,555。最初，这项研究将研究从1999年到2006年对65岁以上男性的雾气程序的使用。我们将与接受TURP的人相比，描述和比较接受雾化疗法的人的社会人口统计学特征，包括比较白人与少数群体成员之间的比率。然后，我们将遵循泌尿科医生的薄雾程序，包括术后诊断测试，使用相同或其他薄雾程序或TURP的重新操作以及其他术后治疗干预措施，在手术后长达7年。将对这些事件的比较进行比较，并在每个薄雾程序和TURP之间进行不同的雾化程序。我们还将报告不同类型的BPH手术的费用，包括术前和术后护理。我们将在BPH手术后长达七年的每种薄雾程序以及每种薄雾程序和TURP之间进行比较。我们还将计算1999年至2006年的BPH手术医疗保险的年度总费用。最后，我们将研究此期间泌尿外科实践的可能变化。我们将比较研究期间（1999年）和后来（2004年）的BPH诊断到手术治疗的时间。此外，使用即将获得的Medicare D部分（处方药）数据，我们将在2006.7（每种类型的手术治疗）之前比较医疗疗法的使用率。公共卫生相关性：在临床试验中已证明了微创手术治疗（雾性手术）的功效；然而，尚不清楚它们对普通人群的有效性和临床影响，以及它们对医疗保健系统的显着增长的影响。传统的有效性措施（与功效相反），例如这些程序在典型的实践环境中的结果，对个人案例和医疗保健付款人（例如Medicare）的成本影响，它们的可用性和对这些新程序的可用性和获取（例如）在传统上处于弱势群体中的种群（例如，对少数民族种族或种族的习惯）以及对练习的效果以及对培训的模式的效果。