Our faculty’s research is frequently accepted for inclusion in the most prestigious peer-reviewed scientific journals, with over 330 articles published in 2015 alone. Below you will find the most recent publications.
The abstracts below are updated daily. For a more complete list, please visit this PubMed link.
Pharmacotherapy versus surgery as initial therapy for patients with moderate-to-severe benign prostate hyperplasia: a cost-effectiveness analysis.
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Pharmacotherapy versus surgery as initial therapy for patients with moderate-to-severe benign prostate hyperplasia: a cost-effectiveness analysis.
BJU Int. 2018 Aug 16;:
Authors: Erman A, Masucci L, Krahn MD, Elterman DS
Abstract
OBJECTIVE: To evaluate the cost-effectiveness of using a surgery such as transurethral resection of the prostate (TURP) or photoselective vaporization of the prostate using greenlight laser (GL-PVP) as initial treatment for men with moderate-to-severe benign prostate hyperplasia (BPH) compared to the standard practice of using pharmacotherapy as initial treatment followed by surgery if symptoms do not resolve.
PATIENTS AND METHODS: We compared a combination of eight strategies involving upfront pharmacotherapy (i.e., alpha-blocker, 5-alpha reductase inhibitor, or combination) followed by surgery (e.g., TURP, or GL-PVP) upon failure vs. TURP or GL-PVP as initial treatment for a target population of men with moderate-to-severe BPH symptom, a mean age of 65-years and no contraindications for treatment. A microsimulation decision-analytic model was developed to project the costs and quality-adjusted life-years (QALYs) of the target population over the lifetime. The model was populated and validated using published literature. Incremental cost-effectiveness ratios (ICERs) were determined. Cost-effectiveness was evaluated using a public payer perspective, a life-time horizon, a discount rate of 1.5% and a cost-effectiveness threshold of $50,000/QALY. Sensitivity and probabilistic analyses were performed.
RESULTS: All options involving an upfront pharmacotherapy followed by TURP for those fail were economically unattractive compared to strategies involving a GL-PVP for those who fail and compared to using either BPH surgery as initial treatment. Overall, upfront TURP was the most costly and effective option followed closely by upfront GL-PVP. On average, upfront TURP cost $1,015 more and resulted in small gain of 0.03 QALYs compared to upfront GL-PVP, translating to an incremental cost per QALY gained of $29,066. Results were robust to probabilistic analysis.
CONCLUSIONS: Surgery is cost-effective as initial therapy for BPH. However, the health and economic evidence should be considered concurrently with patient references and risk attitudes towards different therapy options. This article is protected by copyright. All rights reserved.
PMID: 30113127 [PubMed - as supplied by publisher]
Patient-reported outcomes in patients with overactive bladder treated with mirabegron and tolterodine in a prospective, double-blind, randomized, two-period crossover, multicenter study (PREFER).
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Patient-reported outcomes in patients with overactive bladder treated with mirabegron and tolterodine in a prospective, double-blind, randomized, two-period crossover, multicenter study (PREFER).
Health Qual Life Outcomes. 2018 Apr 19;16(1):69
Authors: Herschorn S, Staskin D, Tu LM, Fialkov J, Walsh T, Gooch K, Schermer CR
Abstract
BACKGROUND: The PREFER study was an assessment of medication tolerability, treatment preference and symptom improvement during treatment with mirabegron (M) and tolterodine (T) extended release (ER) in patients with overactive bladder (OAB). In this analysis of PREFER, patient-reported outcomes (PROs) were assessed during treatment.
METHODS: PREFER was a two-period, 8-week crossover, double-blind, phase IV study (NCT02138747) of treatment-naïve adults with OAB ≥3 months randomized to 1 of 4 treatment sequences (M/T; T/M; M/M; T/T), separated by a 2-week washout. Tolterodine ER was dosed at 4 mg for 8 weeks and mirabegron was dosed at 25 mg for 4 weeks then increased to 50 mg for the next 4 weeks. At each visit, PROs related to treatment satisfaction, quality of life and symptom bother were assessed using the OAB Satisfaction (OAB-S; 3 independent scales/5 single-item overall assessments), OAB-q (total health-related QoL [HRQoL] and subscales [Sleep, Social, Coping, Concern] and Symptom Bother scale) and Patient Perception of Bladder Condition (PPBC) questionnaires. Responder rates were reported for OAB-q subscales based on a minimal important difference (MID; ≥ 10-point improvement) and OAB-S Medication Tolerability score ≥ 90.
RESULTS: In total, 358 randomized patients received ≥1 dose of double-blind study medication and completed ≥1 post-baseline value (OAB-S scale, OAB-q, PPBC): M/T (n = 154), T/M (n = 144), M/M (n = 30) or T/T (n = 30). At end of treatment (EoT), mirabegron and tolterodine ER were associated with similar mean improvements in 7 of the 8 OAB-S scores investigated, OAB-q scales and PPBC. A higher percentage of patients achieved clinically relevant improvements (MID) in OAB-q scales and OAB-S Medication Tolerability score during treatment with mirabegron than tolterodine ER.
CONCLUSIONS: On average, patients with OAB experienced improvements in treatment satisfaction, HRQoL and symptom bother that were of a similar magnitude during treatment with mirabegron or tolterodine ER. However, during mirabegron treatment, patients were more likely to achieve clinically relevant improvements in tolerability and HRQoL (as measured by the MID for the OAB-q or an OAB-S Medication Tolerability score ≥ 90) than during tolterodine ER treatment.
TRIAL REGISTRATION: NCT02138747 ; registered May 13, 2014.
PMID: 29673355 [PubMed - indexed for MEDLINE]