Joanna Coast

Preferences for aspects of a dermatology consultation

Backgroundu2002 General practitioners with special interests (GPSIs) are increasingly being used to provide dermatology services in the U.K. Little is known about U.K. dermatology patient attitudes to proposed variations in secondary care service delivery or the values they attach to aspects of the care they receive.

Transurethral Prostate Resection, Noncontact Laser Therapy or Conservative Management in Men With Symptoms of Benign Prostatic Enlargement? An Economic Evaluation

PURPOSEnWe evaluated the cost-effectiveness of noncontact laser therapy compared with transurethral prostate resection and conservative treatment in men with symptoms associated with benign prostatic enlargement.nnnMATERIALS AND METHODSnA total of 340 men with uncomplicated lower urinary tract symptoms participated in a large multicenter pragmatic randomized trial called the CLasP (Conservative management, Laser therapy, transurethral resection of the Prostate) study. Costs to the United Kingdom National Health Service and patients were determined from the time of randomization to the 7.5-month followup. Incremental cost-effectiveness ratios using conservative management as the base case were calculated for certain trial outcomes, including International Prostate Symptom Score (I-PSS), I-PSS quality of life score, maximum urinary flow, post-void residual urine volume, quality adjusted life-years and a composite measure of success based on I-PSS and maximum urinary flow. One-way sensitivity analysis of the basic costs and incremental cost-effectiveness ratios were done from the NHS viewpoint.nnnRESULTSnMean costs per patient were greatest for noncontact laser therapy and least for conservative management. The incremental cost-effectiveness ratios showed that transurethral prostate resection was more cost-effective than noncontact laser treatment for all primary trial outcomes. The incremental cost-effectiveness ratios of transurethral prostate resection compared with conservative management were pound 81 per unit decrease in the I-PSS score and pound 1,338 per additional successful case per 100 patients. Sensitivity analysis showed that the initial results were robust.nnnCONCLUSIONSnNoncontact laser was the mostly costly treatment option. Transurethral prostate resection was more cost-effective than noncontact laser therapy in terms of symptomatic improvement. In men wishing to delay treatment conservative treatment appears to provide a cost-effective alternative in the short term.

Developing an index of capability for older people: A new form of measure for public health interventions?

Economic evaluation requires monetary measures or a single outcome for use across all interventions to assist decisions about service provision. Monetary values can be estimated through willingness to pay methods but there are difficulties, with few analyses successfully using these methods to value all outcomes (Drummond et al., 2005). Instead, economic evaluation most often uses a single outcome. The quality-adjusted life-year (QALY), as recommended by the National Institute for Health and Clinical Excellence (NICE) in the UK (NICE, 2004), has become the dominant measure within economic evaluation. QALYs may be formed from a number of different measures, including the EQ-5D (Brooks, 1996), the SF-36 (Brazier et al., 2002) and the Health Utility Index (Horsman et al., 2003), but all focus entirely on health as the outcome of interest. The majority of analyses in the UK are currently conducted using EQ-5D, a measure with five dimensions (mobility, self-care, usual activities, pain/discomfort and anxiety/depression) each with three levels (Brooks, 1996).