ABSTRACT
Lower urinary tract symptoms due to benign prostatic hyperplasia constitute a substantial burden, affecting the quality of life of those affected by this condition. While watchful waiting and medical management using a wide array of pharmaceuticals can be effective, surgery has been one of the most definite solutions for those highly affected by this condition. Transurethral resection of the prostate (TURP) is the gold standard surgical procedure, but other alternatives using laser (HoLEP and ThuLEP) and robotic water jets (Aquablation) are emerging treatments aimed at reducing postoperative morbidity. Minimally invasive procedures conducted in outpatient settings and under local anesthesia or sedation are increasingly being used, especially in those patients with high surgical risk due to comorbidities. These procedures include prostatic arterial embolization, water vapor thermal therapy (Rezum), prostatic urethral lift (Urolift), temporary implantable nitinol device (TIND/iTIND), and transurethral microwave thermotherapy (TUMT). The evidence supporting these treatments is growing, but some uncertainties remain as to what is the magnitude of their advantages and disadvantages compared to TURP. Innovations in the technologies involved in these new procedures may improve their profile for effectiveness and safety. Moreover, new devices are being investigated for marketing approval. Issues around costs and patients' preferences are also yet to be elucidated, thus their evolving role needs to be weighed against the aforementioned considerations.
ABSTRACT
OBJECTIVES: To assess patients' preferences for rheumatoid-arthritis treatments with biologic agents using a discrete-choice experiment. METHODS: A discrete-choice experiment was conducted with adult rheumatoid-arthritis patients who had never been treated with biological agents from two university hospitals-public and private-in Buenos Aires, Argentina. We evaluated preferences for seven treatment attributes (with two to three levels each): effectiveness, mode of administration, frequency of administration, local and systemic adverse events, severe infections, and out-of-pocket costs.A probit regression model was used to analyze the relative importance of rheumatoid-arthritis treatment attributes. We estimated attributes' relative importance and their 95% confidence intervals. RESULTS: Survey responses from 240 patients with rheumatoid arthritis receiving conventional disease-modifying antirheumatic drugs were included in the study. All tested biological agents' attributes significantly affected the choice of treatment. Attributes' relative importance in decreasing order was the following (mean, confidence interval 95%): cost, 0.81 (0.69-0.92); systemic adverse events, 0.66 (0.57-0.76); frequency of administration, 0.61 (0.52-0.71); efficacy, 0.42 (0.32-0.51); route of administration, 0.41 (0.30-0.52); local adverse events, 0.40 (0.31-0.49); and serious infections, 0.29 (0.22-0.37). CONCLUSIONS: Different treatment attributes had a significant and different influence in rheumatoid-arthritis patients' choice of biological agents. This type of study can not only inform about patients' preferences but also about the trade-offs among different possible treatments or process-related attributes.
Subject(s)
Antirheumatic Agents/therapeutic use , Arthritis, Rheumatoid/drug therapy , Biological Products/therapeutic use , Patient Preference/statistics & numerical data , Adult , Aged , Antirheumatic Agents/administration & dosage , Antirheumatic Agents/adverse effects , Antirheumatic Agents/economics , Argentina , Arthritis, Rheumatoid/psychology , Biological Products/administration & dosage , Biological Products/adverse effects , Biological Products/economics , Choice Behavior , Confidence Intervals , Female , Humans , Interviews as Topic , Male , Middle Aged , Patient Preference/psychology , Regression Analysis , Severity of Illness Index , Young AdultABSTRACT
La hiperplasia prostática benigna es un problema de salud molesto y relativamente frecuente en los hombres. La siguiente nota es una actualización sobre el beneficio de la evidencia existente para su tratamiento con los bloqueantes de los receptores alfa o alfa bloqueantes y con los inhibidores de al 5 alfa reductasa.
Subject(s)
Humans , Male , Prostatic Hyperplasia , Prostatic Hyperplasia/drug therapy , Prostatic Hyperplasia/therapy , Prostate/abnormalities , Drug Therapy , Combined Modality Therapy , PharmacologyABSTRACT
Los beta bloqueantes son ampliamente usados en atención primaria para el tratamiento de varias entidades, siendo la más frecuente sin duda la hipertensión arterial. Existen diferentes tipos de beta bloqueantes, que en general se acepta que comparten la eficacia y el mismo mecanismo de acción, aunque pueden diferir en su capacidad de producir efectos adversos. Se ha demostrado claramente que el tratamiento con beta bloqueantes en prevención secundaria cardiovascular conlleva a un aumento de la sobrevida1; a partir de esta observación se ha generado el siguiente cuestionamiento: ¿Tienen los betabloqueantes el mismo beneficio cardioprotector en pacientes con hipertensión arterial sin evidencia de enfermedad coronaria?
