Healtheconomics Evaluation With Markov Model To Four Treatment Strategies Of Benign Prostatic Hyperplasia (BPH)

Objective: To supply scientific information to decision maker, Markov model to conduct cost-effectiveness analysis of the druggery treatment(α₁-blockers and 5α-reductatse inhibitors) and surgery treatment(Open Prostatectomy and Transurethral Resection of the Prostate) for BPH.Methods: treatment strategies of cost-effectiveness analysis in the druggery and surgery treatment were selected, based on the "the research of sequel of medical treatment for the disease of the elderly" and pertinent clinic research publications of BPH. The Markov model was developed based on the progress after the clinic treatment of BPH. The data of transition probability used for model simulation were collected from related clinic research publications. Using the research result of "The Fifteenth Plan" of our country——"the research of sequel of medical treatment for the disease of the elderly" to calaculate the state utility and the cost of treatments strategies of BPH.The Roll Back analysis, Markov cohort simulation and Monte Carlo were used to analyse the cost-effectiveness, cost-benefit and cost-utility of each treatment of druggery and surgery. Markov model Monte Carlo simulation combined with Bootstrap method was used to estimate cost-effectiveness ratio, increment cost-effectiveness ratio, increment Net monetary benefit and increment Net health benefit. At the same time, one-way sensitivity analysis and two-way sensitivity analysis were used to analyse uncertainty of the research result.Results: 1. The analysis of base-case roll back showed that the cost-effectiveness ratios ofα₁-blockers and 5α-reductatse inhibitors were 3568 Yuan/QALY and 5556 Yuan/year, respectively. Markov Cohort simulation analysis showed that death rate would tend to be 100% when the Markov model was circulated up to 60th. The accumulative cost and effectiveness ofα₁-blockers were 15960.4 yuan and 4.47 QALYs, respectively, the accumulative cost and effectiveness of 5α-reductatse inhibitors were 23620.2 yuan and 4.47 QALYs. One time of Markov Monte Carlo simulation showed that the cost-effectiveness ratio of α₁-blockers and 5α-reductatse inhibitors were 3568yuan/QALY (95%CI: 3511.23 yuan/QALY～3624.77 yuan/QALY) and 5556 yuan/ QALY (95%CI: 5495.17 yuan/QALY～5616.83 yuan/QALY). Theα₁-blockers was the base line in the druggery treatment analysis, the Markov Monte Carlo was repeated 60 times to estimate increment cost-effectiveness ratio, increment Net monetary benefit and increment Net health benefit, their value were -1988. 7 yuan/QALY (95%CI: -1974.9 yuan/QALY～-2002.5 yuan/QALY),-29677.0 yuan (-29597.9 yuan～-29736.1 yuan) and -0.29 QALYs (-0.289 QALYs～-0.291 QALYs), respectively.2. The analysis of base-case roll back showed that the cost-effectiveness ratios of Open Prostatectomy and Transurethral Resection of the Prostate were 6748.0 Yuan/QALY and 9219.6 Yuan/QALY, respectively. Markov Cohort simulation analysis showed that death rate would tend to be 100% when the Markov model was circulated up to 44th. The accumulative cost and effectiveness of Open Prostatectomy were 15044.0 yuan and 2.23 QALYs, respectively; The accumulative cost and effectiveness of Transurethral Resection of the Prostate were 17496.0 yuan and 1.89 QALYs, respectively. One time of Markov Monte Carlo simulation showed that the cost-effectiveness ratio of Open Prostatectomy and Transurethral Resection of the Prostate were 6750 yuan/QALY (95%CI: 6727.3 yuan/QALY～6772.7 yuan/QALY) and 9223.7yuan/year (95%CI: 9185.0 yuan/QALY～9262.4 yuan/QALY), respectively. The Open Prostatectomy was the base line in the surgery treatment analysis, the Markov Monte Carlo was repeated 60 times to estimate increment cost-effectiveness ratio, increment Net monetary benefit and increment Net health benefit, their value were -2473.7 yuan/QALY (95%CI: -2466.5 yuan/QALY～-2480.8 yuan/QALY), -42867.6 yuan (-42842.3 yuan～-42892.9 yuan) and -0.36 years (-0.359 QALYs～-0.361 QALYs), respectively.Conclusions: 1. Cost-effectiveness ratio ofα₁-blockers was less than that of 5α-reductatse inhibitors in the druggery. Net monetary benefit and Net health benefit ofα₁-blockers were higher than that of 5α-reductatse inhibitors. Therefore,α₁-blockers is better than 5α-reductatse inhibitors when the druggery is selected. 2. Cost-effectiveness ratio, Net monetary benefit and Net health benefit of Open Prostatectomy were less than that of Transurethral Resection of the Prostate in the surgery. Net monetary benefit and Net health benefit of Open Prostatectomy were higher than that of Transurethral Resection of the Prostate. Therefore, Open Prostatectomy is better than Transurethral Resection of the Prostate when the druggery is selected. 3. It is recommended to use Markov model to conduct Healtheconomics evaluation of treatment strategies for BPH.