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Value-based care for the treatment and evaluation of benign prostatic hyperplasia: an analysis of a metropolitan service area claims database

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Abstract

Purpose

With an aging population, cost containment and improved outcomes will be crucial for a sustainable healthcare ecosystem. Current data demonstrate great variation in payments for procedures and diagnostic workup of benign prostatic hyperplasia (BPH). To help determine the best financial value in BPH care, we sought to analyze the major drivers of total payments in BPH.

Materials and methods

Commercial and Medicare claims from the Truven Health Analytics Markestscan® database for the Austin, Texas Metropolitan Service Area from 2012 to 2014 were queried for encounters with diagnosis and procedural codes related to BPH. Linear regression was utilized to assess factors related to BPH-related payments. Payments were then compared between surgical patients and patients managed with medication alone.

Results

Major drivers of total payments in BPH care were operative, namely transurethral resection of prostate (TURP) [$2778, 95% CI ($2385–$3171), p < 0.001) and photoselective vaporization (PVP) ($3315, 95% CI ($2781–$3849) p < 0.001). Most office procedures were also associated with significantly higher payments, including cystoscopy [$708, 95% CI ($417–$999), p < 0.001], uroflometry [$446, 95% CI ($225–668), p < 0.001], urinalysis [$167, 95% CI ($32–$302), p = 0.02], postvoid residual (PVR) [$245, 95% CI ($83–$407), p < 0.001], and urodynamics [$1251, 95% CI ($405–2097), p < 0.001]. Patients who had surgery had lower payments for their medications compared to patients who had no surgery [$120 (IQR: $0, $550) vs. $532 (IQR: $231, $1852), respectively, p < 0.001].

Conclusion

Surgery and office-based procedures are associated with increased payments for BPH treatment. Although payments for surgery were more in total, surgical patients paid significantly less for BPH medications.

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Abbreviations

BPH:

Benign prostatic hyperplasia

TURP:

Transurethral removal of the prostate

PVP:

Photoselective vaporization

PVR:

Post-void residual

PSA:

Prostate specific antigen

MSA:

Metropolitan service area

EVP:

Electro vaporization of prostate

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Authors and Affiliations

  1. The University of Texas At Austin-Dell Medical School, Austin, USA

    Jack C. Webb, Victoria E. Valencia, Jessica Wenzel, Anish Patel, J. Stuart Wolf Jr. & E. Charles Osterberg

Authors
  1. Jack C. Webb
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  2. Victoria E. Valencia
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  3. Jessica Wenzel
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  4. Anish Patel
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  5. J. Stuart Wolf Jr.
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  6. E. Charles Osterberg
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Contributions

JW: project development and manuscript writing/editing. VEV: data collection, management, analysis and manuscript writing/editing. JW: manuscript writing/editing. AP: manuscript writing/editing. JSW: Protocol/project development and manuscript editing. ECO: protocol/project development and manuscript editing.

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Correspondence to Jack C. Webb.

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Webb, J.C., Valencia, V.E., Wenzel, J. et al. Value-based care for the treatment and evaluation of benign prostatic hyperplasia: an analysis of a metropolitan service area claims database. World J Urol 38, 3245–3250 (2020). https://doi.org/10.1007/s00345-020-03109-y

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  • DOI: https://doi.org/10.1007/s00345-020-03109-y

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