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Improvement of quality in clinical care for patients with benign prostatic hyperplasia: Cost effectiveness analysis.

INTRODUCTION
Currently, St. Carolus Hospital (SCH), Jakarta, Indonesia is using a combination therapy for patients with benign prostatic hyperplasia (BPH) based on the clinical practice guidelines (CPG). In this study, we used two methods of administering combination therapy, namely, the standard method and the modified method. To date, no research has been conducted to reduce the cost burden of BPH medication without reducing the quality of service. Thus, this study aimed to compare the clinical outcomes and quality of life (QoL) of the modified therapeutic method with those of the standard therapeutic method and perform cost-effective analysis of the two therapeutic methods available at SCH.


MATERIALS AND METHODS
The study design used was a retrospective cohort. Data were obtained from medical records at SCH and interviews. Decision tree analysis was used for this study based on clinical outcomes and costs. Clinical outcomes and costs were compared between the standard and modified therapy models. Interviews were conducted to obtain cost data from a societal perspective. Then, the data were analyzed using SPSS statistics program and MS Excel.


RESULTS
A total of 100 BPH patients met the inclusion criteria. The mean age in the standard therapy and modified therapeutic method groups was 66.92 (SD±6.67) and 67.10 (SD 8.49) years, respectively. At the start of therapy, the mean international prostate symptom score (IPSS) in the standard method group was lower than that in the modified group (15 vs 17), but the mean Qmax in both groups was the same (9 ml/s). In addition, the mean QoL score in both groups was 4 (not satisfied). At the end of therapy, there was an improvement in the IPSS, Qmax and QoL was observed in both groups. In the Mann Whitney statistical test, there was no significant difference in IPSS and QoL was found between the standard therapeutic method group and the modified therapeutic method group (P = 0.07 and P = 0.498). In the unpaired T test, there was a significant difference in Qmax was found between the standard method group and the modified method group (p = 0.039, 95%CI, -3.20529 to - 0.8769). The effectiveness of standard therapeutic methods and modified therapy methods is 82% and 90%, respectively. The average cost of standard therapeutic methods is greater than that of modified therapeutic methods per visit. Furthermore, the average cost-effectiveness ratio of the modified therapeutic method is lower than that of the standard therapeutic method.


CONCLUSION
The Modified therapeutic method has better results regarding the maximum urinary flow rate compared with the standard therapeutic method. The modified therapeutic method is also more cost-effective than the standard therapeutic method. This study can be used as the basis for service standards in hospitals and national health technology assessments as a policy direction for the national health insurance benefit package.