Volume 4, Issue 1 (5-2016)                   Jorjani Biomed J 2016, 4(1): 66-80 | Back to browse issues page

XML Persian Abstract Print


Download citation:
BibTeX | RIS | EndNote | Medlars | ProCite | Reference Manager | RefWorks
Send citation to:

Mahboub-Ahari A, Hajebrahimi S, Sadeghi-Ghyassi F, Yousefi M, radin manesh M. The use of Holmium and Tolmium YAG Laser-assisted technologies in benign prostatic hyperplasia surgery: A health technology assessment study. Jorjani Biomed J 2016; 4 (1) :66-80
URL: http://goums.ac.ir/jorjanijournal/article-1-442-en.html
1- Tabriz University of Medical Sciences
2- Iranian Evidence-Based Medicine Center of Excellence, Tabriz University of Medical Sciences, Tabriz, Iran , hajebrahimis@gmail.com
3- Tehran University of medical sciences
Abstract:   (10802 Views)

Background & Objectives: Current study aimed to compare effectiveness and cost effectiveness of laser devices in BPH surgery. This study could provide clear evidences which could be used in prior approval and funding of such new emerging technologies.

Methods: A systematic search of related databases was performed to find Randomized clinical trials, systematic reviews, Meta analyses and health technology assessment studies which had been published up to 2008.key words are: Laser، Holmium YAG laser (HOLEP)، Tolmium Laser، Transurethral Resection of the Prostate (TURP) and prostate. Data for clinical effectiveness was retrieved from the literature. Two Laser Assisted Technologies were analyzed in terms of efficacy, effectiveness and cost-effectiveness and compared with Trans-Urethral Resection of the Prostate (TURP) method from the perspective of Iran Ministry of Health. We used standard costing for analysis of costs. One-way sensitivity analysis was performed for the examination of calculated ICER in different probable scenarios.

Results: Literature review stressed that there is no statistically significant difference in clinical effectiveness of Lasers assisted devices and TURP technique. The length of hospital stay and severity of side effects are clinically and statistically lower in Laser Assisted devices. Estimated unit-cost of treatment for Tolmium, Holmium and TURP was 3403541, 3019261 and 2455794 (RLS) from MOH perspective and 340354, 4719261 and 4325794 from societal perspective.

Conclusion: Sensitivity analysis showed that, in most of the study scenarios TURP was dominant intervention because of low treatment costs. Tolmium laser only with the assumption of dual applicability and 200 patients per year would be considered as a cost-effective technology.

Full-Text [PDF 699 kb]   (3620 Downloads)    
Type of Article: Original article | Subject: General medicine
Received: 2016/08/13 | Accepted: 2016/08/13 | Published: 2016/08/13

References
1. Mahboub Ahari A, Sadeghi Ghyassi F, Yousefi M, Amjadi M, Mostafaie A. Greenlight photo selective vaporization of the prostate vs. transurethral resection of prostate for benign prostatic hyperplasia: J Lasers Med Sci. 2011; 2(4):152-8.
2. Basiri A, Mousavi SM, Naghavi M, Araghi IA, Namini SA. Urologic diseases in the Islamic Republic of Iran: what are the public health priorities? Eastern Mediterranean health journal. 2008; 14(6): 1406-16.
3. Safarinejad MR. Prevalence of benign prostatic hyperplasia in a population based study in Iranian men 40 years old or older. International Urology and Nephrology 2008;40(4):921-31
4. Fitzpatrick JM. The natural history of benign prostatic hyperplasia. BJU international 2006;97(s2):3-6.
5. Fong YK, Milani S, Djavan B. Natural history and clinical predictors of clinical progression in benign prostatic hyperplasia. Current Opinion in Urology 2005;15:35-8.
6. Wasson JH, Reda DJ, Bruskewitz RC, Elinson J, Keller AM, Henderson WG. A comparison of transurethral surgery with watchful waiting for moderate symptoms of benign prostatic hyperplasia. New England Journal of Medicine. 1995; 332(2), 75-79.
7. Reich O, Gratzke C, Stief CG. Techniques and long-term results of surgical procedures for BPH. European urology. 2006;49(6):970-8.
8. Kuntz RM. Current role of lasers in the treatment of benign prostatic hyperplasia (BPH). European urology. 2006;49(6):961-9.
9. Barry MJ, Fowler FJ, Jr., O'Leary MP, Bruskewitz RC, Holtgrewe HL, Mebust WK, et al. The American Urological Association symptom index for benign prostatic hyperplasia. The Measurement Committee of the American Urological Association. J Urol. 1992;148(5):1549-57.
10. Lourenco T, Pickard R, Vale L, Grant A, Fraser C, MacLennan G et al. Alternative approaches to endoscopic ablation for benign enlargement of the prostate: systematic review of randomized controlled trials. BMJ. 2008 Jun 30;337:a449.
11. Gupta N, Sivaramakrishna, Kumar R, Dogra PN, Seth A. Comparison of standard transurethral resection, transurethral vapor resection and holmium laser enucleation of the prostate for managing benign prostatic hyperplasia of >40 g. BJU Int. 2006;97(1):85-9.
12. Kuntz RM, Ahyai S, Lehrich K, Fayad A. Transurethral holmium laser enucleation of the prostate versus transurethral electrocautery resection of the 8 prostate: a randomized prospective trial in 200 patients. J Urol 2004;172(3):1012-6.
13. Montorsi F, Naspro R, Salonia A, Suardi N, Briganti A, Zanoni M et al. Holmium laser enucleation versus transurethral resection of the prostate: results from a 2- center, prospective, randomized trial in patients with obstructive benign prostatic hyperplasia. J Urol 2004;172(5 Pt 1):1926-9.
14. Wilson LC, Gilling P, Williams A, Kennett KM, Frampton CM, Westenberg AM et al. A randomized trial comparing holmium laser enucleation versus transurethral resection in the treatment of prostates larger than 40 grams: results at 2 years. Eur Urol. 2006;50:569-73.
15. Dubey D, Muruganandham K. Thulium laser versus standard transurethral resection of the prostate: A randomized prospective trial. Indian J Urol. 2008 Jul; 24(3):428-9.
16. Xia SJ, Zhuo J, Sun XW, Han BM, Shao Y, Zhang YN. Thulium laser versus standard transurethral resection of the prostate: a randomized prospective trial. Eur Urol. 2008 Feb;53(2):382-89.
17. Elliot R, Payne K. Essentials of Economic Evaluation in Health care. London: Pharmaceutical Press; 2005.
18. Drummond MF, Sculpher MJ, Torrance GW, O’Brien BJ, Stoddart GL eds. Methods for economic evaluation of health care programs, 3rd ed. Oxford: Oxford University Press; 2005.
19. Muenning P. Cost effectiveness analysis in health: A practical approach, 2nd ed. San Francisco: Jossey- Bass; 2008.

Add your comments about this article : Your username or Email:
CAPTCHA

Send email to the article author


Rights and permissions
Creative Commons License This work is licensed under a Creative Commons Attribution-NonCommercial 4.0 International License.

© 2024 CC BY-NC 4.0 | Jorjani Biomedicine Journal

Designed & Developed by : Yektaweb