Evaluating Patient Preferences in Benign Prostatic Hyperplasia Treatment Using Conjoint Analysis

The Evolving Landscape of Discrete Choice Experiments in Health Economics: A Systematic Review

INTRODUCTION

Stakeholder preference evaluations are increasingly emphasized in healthcare policy and health technology assessment. Discrete choice experiments (DCEs) are the most common method for quantifying preferences among patients, the public, and healthcare professionals. While prior reviews (1990-2017) have examined DCE trends, no comprehensive synthesis exists for studies published since 2018. This updated review (2018-2023) provides critical insights into evolving methodologies and global trends in health-related DCEs.

METHODS

A systematic search (2018-2023) of Medline, Embase, and Web of Science identified relevant studies. Studies were screened for inclusion and data were extracted, including details on DCE design and analysis. To enable trend comparisons, the search strategy and extraction items aligned with previous reviews.

RESULTS

Of 2663 identified papers, 1279 met the inclusion criteria, reflecting a significant rise in published DCEs over time. DCEs were conducted globally, with a remarkable increase in publications from Asia and Africa compared with previous reviews. Experimental designs and econometric models have advanced, continuing prior trends. Notably, most recent DCEs were administered online.

DISCUSSION

The rapid growth of DCE applications underscores their importance in health research. While the methodology is advancing rapidly, it is crucial that researchers provide full transparency in reporting their methods, particularly in detailing experimental designs and validity tests, which are too often overlooked. Key recommendations include improving reporting of experimental designs, applying validity tests, following good practices for presenting benefit-risk attributes, and adopting open science practices. Ensuring methodological rigor will maximize the impact and reproducibility of DCE research in health economics.

Patient preferences for life expectancy cutoffs for aggressive treatment in clinically localized prostate cancer

BACKGROUND

Guidelines for prostate cancer treatment in men with limited life expectancy are based on expert opinion. Patient preferences for when to defer treatment based on longevity are unknown. We sought to define life expectancy thresholds at which men are more likely to choose conservative management in the context of varying risks of cancer death and treatment-related side effects.

MATERIALS AND METHODS

We crowdsourced a conjoint analysis exercise to 2,046 men sociodemographically matched to a US prostate cancer population. Subjects were given a longevity estimate based on their age and comorbidity. They then chose between treatment and conservative management across scenarios with varying risks of cancer death at 5, 10, and 15 years, erectile dysfunction, urinary incontinence, and irritative urinary symptoms. Multivariable multinomial logistic regression identified the life expectancy threshold when men were more likely to choose conservative management over treatment.

RESULTS

Across all men, there was a significant interaction between longevity and treatment choice (P < 0.001), with probability of treatment decreasing 15% for every 5-year decrease in life expectancy (OR0.85, 95% CI0.82-0.89). Across all tumor risk subtypes, men were significantly more likely to choose conservative management at life expectancy<10 years(OR<1, P < 0.05). For low-, favorable-intermediate-, unfavorable-intermediate-, and high-risk cancers, men were more likely to choose conservative management at life expectancy thresholds of ≤15, ≤10, ≤9, and ≤7 years, respectively (P < 0.05).

CONCLUSIONS

Preferences for when to consider conservative management of prostate cancer based on longevity align with current guidelines recommendations, except for low-risk disease, for which men are likely to consider conservative management at even higher life expectancy thresholds.

Exploring TGF-β signaling in benign prostatic hyperplasia: from cellular senescence to fibrosis and therapeutic implications

As men get older, they often develop benign prostatic hyperplasia (BPH), an enlarged prostate that is not cancerous or dangerous. Although the etiology of BPH is unknown, increasing evidence indicates that the TGF-β signaling pathway might be a key player in its pathogenesis. TGF-β is a pleiotropic cytokine involved in proliferation, differentiation, and extracellular matrix re-modeling, which are all dysregulated in BPH. Cellular senescence is primarily initiated by TGF-β--induced, irreversible growth arrest and usually limits the prostate gland's hyperplastic growth. Moreover, senescent cells generate a Senescence-Associated Secretory Phenotype (SASP), which consists of numerous proinflammatory and profibrotic factors that can worsen disease ontogeny. In addition, TGF-β is among the most fibrogenic factors. At the same time, fibrosis involves a massive accumulation of extracellular matrix proteins, which can increase tissue stiffness and a loss of normal organ functions. TGF-β-mediated fibrosis in BPH changes the mechanical properties of the prostate and surrounding tissues to contribute to lower urinary tract symptoms. This review discusses the complicated molecular signaling of TGF-β underlying changes in cellular senescence and fibrosis during BPH concerning its therapeutic potential.

A real-world evidence study of interhospital variability in the surgical treatment of patients with benign prostatic hyperplasia: the REVALURO study

PURPOSE

Lower urinary tract symptoms associated with benign prostatic hyperplasia (LUTS/BPH) is a growing condition in males associated with a high clinical, economic and humanistic burden. Several surgical techniques are available for the treatment of LUTS/BPH; thus, the aim of this study was to describe and explore the variability in the use of surgical procedures among Spanish hospitals.

METHODS

The REVALURO was a retrospective, observational study conducted by collecting data from the clinical records of patients with LUTS/BPH aged ≥ 35 years, from 5 national reference hospitals, who were surgically treated between 2018 and 2022.

RESULTS

Among the 3038 patients who underwent 3084 surgeries, 66% were invasive (2018: 57.5%, 2022: 71.5%), 22% were minimally invasive (MISTs) (2018: 20.7%, 2022: 20.2%) and 12% were highly invasive (2018: 21.8%, 2022: 8.4%). A total of 22.4% of patients' complications, with a maximum incidence of 28.6% (open prostatectomy) and a minimum 0.8% (water vapor thermal therapy (WVTT)] (p < 0.001). The reintervention rate was 1.5% over the study period. The median length of hospital stay after surgery increased from 0 days (interquartile range [IQR]: 0) with WVTT to 5 days (IQR: 4-8) with open prostatectomy (p < 0.001).

CONCLUSION

Trends in surgical treatment showed that the use of invasive techniques increased, while the use of highly invasive techniques decreased, and the use of MISTs remained constant. However, given the heterogeneity among hospitals, national clinical guidelines and recommendations are needed to guide the decision on which technique should be used and to homogenize the criteria.

Comparative assessment of attitudes and expectations: Iranian patients versus urologists in the management of benign prostatic hyperplasia

BACKGROUND

Benign prostatic hyperplasia (BPH) is common and presents as lower urinary tract symptoms (LUTS). Understanding patient concerns and treatment preferences is essential for effective management. This study aimed to investigate the attitudes, preferences, and expectations of Iranian patients with BPH, and compare them with those of urologists in addressing this condition.

METHODS

A cohort of patients diagnosed with BPH underwent assessment during their initial visit. Before any counseling, their attitudes, concerns, and expectations regarding benign prostate enlargement were evaluated using semi-structured interviews. Patient responses were analyzed based on educational levels and age. Additionally, correspondence was initiated with thirty urologists who graduated within the past twelve years to assess their attitudes toward BPH, concerns, and treatment approaches. Interview questions were constructed using the Delphi method, and their validity was confirmed. Responses from both groups were analyzed and compared. Descriptive statistics, independent t-test, Chi-squared test, Mann-Whitney U, and principal component analysis (PCA) with varimax rotation were used for statistical analysis.

RESULTS

The study comprised 261 patients and 30 urologists. Findings revealed that 86.2% of patients and 86.7% of urologists perceived a lack of sufficient patient knowledge about BPH. Patients across all educational levels and age groups expressed a desire for more information about their condition. Primary concerns among patients included exacerbation of urinary symptoms, potential malignancy, and sexual dysfunction. While patients generally preferred pharmacological treatments, those older than 75 years showed a significantly higher preference for surgical options. Conversely, urologists exhibited greater concern for long-term clinical complications associated with BPH. Results indicated significant parallels between the attitudes of urologists and patients in assessing the multifaceted impact of BPH on patient well-being.

CONCLUSION

This study enhances our understanding of patient attitudes and concerns regarding BPH, thereby facilitating more effective treatment strategies. Our findings encourage urologists to enhance patient perspectives by delivering comprehensive information. Furthermore, the comparison between patient and urologist attitudes towards BPH underscores the importance of tailored care and patient-centered approaches in optimizing outcomes for individuals with BPH.

Influence of chronic medical conditions on older patients' willingness to deprescribe medications: a cross-sectional study

BACKGROUND

Aging correlates with a heightened prevalence of chronic diseases, resulting in multimorbidity affecting 60% of those aged 65 or older. Multimorbidity often leads to polypharmacy, elevating the risk of potentially inappropriate medication (PIM) use and adverse health outcomes. To address these issues, deprescribing has emerged as a patient-centered approach that considers patients' beliefs and attitudes toward medication and reduces inappropriate polypharmacy in older adults. Our study aims to investigate whether certain chronic medical conditions are associated with older patients' willingness to deprescribe medications.

METHODS

A cross-sectional study enrolled 192 community-dwelling individuals aged 65 or older taking at least one regular medication. Data included demographics, clinical characteristics, and responses to the Portuguese revised Patients' Attitudes Towards Deprescribing (rPATD) questionnaire. Descriptive statistics characterized participants, while multiple binary logistic regression identified associations between chronic medical conditions and willingness to deprescribe.

RESULTS

Among the participants (median age: 72 years, 65.6% female), 91.6% had multimorbidity. The analysis revealed that willingness to deprescribe significantly increased with the presence of gastric disease (adjusted odds ratio [aOR] = 4.123; 95% CI 1.221, 13.915) and age (aOR = 1.121; 95% CI 1.009, 1.246). Conversely, prostatic pathology (aOR = 0.266; 95% CI 0.077, 0.916), higher scores in the rPATD appropriateness factor (aOR = 0.384; 95% CI 0.190, 0.773), and rPATD concerns about stopping factor (aOR = 0.450; 95% CI 0.229, 0.883) diminished patients' willingness to deprescribe.

CONCLUSIONS

This study highlights the intricate relationship between older patients' attitudes toward deprescribing and chronic medical conditions. We found that gastric disease was associated with an increased willingness to deprescribe medications, while prostate disease was associated with the opposite effect. Future research should explore how patients with specific diseases or groups of diseases perceive deprescribing of medications general and for specific medications, aiding in the development of targeted interventions.

Investigating trends in interest for benign prostatic hyperplasia surgery options using Google Trends

Understanding patient interest among surgical options is challenging. We used Google Trends to analyze interest in benign prostatic hyperplasia (BPH) surgeries recommended for prostate volumes <80 cc. Google Trends was queried with five BPH surgeries. Final rank of search terms was TURP, UroLift, Rezum, Aquablation, and Greenlight. Google Trends can be an effective tool for evaluating public interest trends in BPH surgery.