- Email: [email protected]
Care management of patients with benign prostatic hyperplasia in Spain
Actas Urol Esp. 2013;37(1):60---62
Actas Urológicas Españolas www.elsevier.es/actasuro
LETTERS TO THE EDITOR Care management of patients with benign prostatic hyperplasia in Spain夽 Manejo asistencial del paciente con hiperplasia benigna de próstata en Espa˜ na Dear Editor: Now more than ever, it is necessary to prioritize the use of more efficient resources by public institutions. In the field of health, we intend to achieve a quality healthcare, as well as an optimal use of the available resources to achieve the best treatment for the patients. As a result, the pharmacoeconomic analysis of different treatment options takes greater importance, especially for the chronic and most prevalent diseases, such as benign prostatic hyperplasia (BPH), as they involve higher cost for the system.1 Regarding the recently published study in this journal, Care management of patients with benign prostatic hyperplasia in Spain,1 which describes the actual management of patients with BPH, heterogeneity was observed in medical practice in primary care, which could generate inefficiency bubbles in the use of healthcare resources. It was therefore considered relevant to conduct further analysis, comparing the use of healthcare resources and the costs associated to the care management observed in this study to the use of resources and cost associated if expert recommendations’ criteria for referral in benign prostatic hyperplasia for priTable 1a
Costs of visits and tests performed of the different patterns observed per patient and year. Total costs
AP 1 AP 2 AP 3 AP 4 AP5 AP6 AP7 Criteria
mary care’ (criteria) were followed.2,3 To this end, on the basis of the patterns of care identified in the published study, and considering both the diagnosis and the follow-up of the disease, we calculated the annual cost/patient associated to each pattern, assigning to each resource used (diagnostic, follow-up tests, and medical visits) its unit cost (euros from 2012) obtained from published rates and multiplying by its frequency. Following the same methodology, we performed the quantification of the costs associated with the care management recommended in criteria. The variability in clinical practice results in variability in costs. Thus, the associated costs of the different patterns of care observed range from D 252.99 to D 1.250.74 per patient and year, while the costs associated to the care management recommended by criteria were between D 193.32 and 340.72 (Tables 1a and 1b). Based on these costs, if we had a fixed budget of D 100,000, adjusting for the frequency of each pattern and the prevalence of the clinical status of BPH, we could treat 237 patients/year, while criteria would make it possible to treat 471 patients/year. Therefore, the follow-up of criteria would enable to treat twice the number of patients a year by means of the care observed in the study. Therefore, the implementation of recommendations of experts could help achieve a more efficient use of the resources, without compromising the quality of patient care, achieving cost savings that could be redistributed and which could also reduce the variability in the treatment of patients.
D 666.78 D 546.96 D 1250.74 D 457.28 D 587.55 D 681.57 D 503.52 D 579.87
Cost of the visits
Cost of the test
D 72.31 D 72.31 D 83.97 D 69.98 D 74.64 D 69.98 NA D 88.44
D 146.48 D 108.50 D 147.80 D 111.93 D 111.92 D 51.49 NA D 37.70
Total cost of the diagnosis D 218.79 D 180.81 D 231.78 D 181.91 D 186.56 D 121.47 D 218.79 D 126.14
AP patterns 5, 6, 7 show no symptomatology difference; mild, moderate, and severe patients follow AP patterns 1 and 3; mild and moderate patients follow and severe ones refer AP patterns 2, 4 and Criteria; Mod.: moderate.
夽 Please cite this article as: Cózar JM, Huerta A, en representación del Comité Científico del estudio. Manejo asistencial de pacientes con hiperplasia benigna de próstata en Espa˜ na. Actas Urol Esp. 2013;37:60---1.
2173-5786/$ – see front matter © 2012 AEU. Published by Elsevier España, S.L. All rights reserved.
LETTERS TO THE EDITOR Table 1b
Costs of visits and tests performed of the different patterns observed per patient per year.
Mild AP 1 AP 2 AP 3 AP 4 AP5 AP6 AP7 Criterios
61
Cost of the visits
Cost of the tests
Total cost of the follow-up
Classification
Classification
Classification
Mod.
D 109.60 D 137.12 D 140.85 D 160.67
D 132.46 D 164.17 D 134.79 D 107.74
D 29.48
D 88.44
Severe D 166.97 D 153.45 D 90.25 D 65.53 D 118.93
Mild
Mod.
D 338.38 D 139.35 D 308.94 D 165.99
D 195.70 D 242.56 D 136.96 D 64.69
D 37.70
D 126.14
Severe D 864.97 D 194,65 D 145.91 D 65.99 D 489.26
Mild
Mod.
D 447.99 D 276.47 D 449.79 D 326.66
D 328.16 D 406.74 D 271.75 D 172.43
D 67.18
D 214.58
Severe D 1031.94 D 348.10 D 236.16 D 131.51 D 608.19
AP patterns 5, 6, 7 show no symptomatology difference; mild, moderate, and severe patients follow AP patterns 1 and 3; mild and moderate patients follow and severe ones refer AP patterns 2, 4 and Criteria; Mod.: moderate.
References 1. Cozar JM, Solsona E, Brenes F, Fernández-Pro A, León F, Molero JM, et al. Manejo asistencial del paciente con hiperplasia benigna de próstata en Espa˜ na. Actas Urol Esp. 2011;35:580---8. 2. Casti˜ neiras J, Cozar JM, Fernández-Pro A, Martín JM, Brenes FJ, Naval E, et al. Criterios de derivación en hiperplasia benigna de próstata para atención primaria. Actas Urol Esp. 2010;34:24---34. 3. Cozar JM, Casti˜ neiras J. Criterios de derivación de la hiperplasia benigna de próstata para atención primaria 2011. Versión 2011. Actas Urol Esp. 2012;36:203---4.
Renal juxtaglomerular cell tumor夽 Tumor renal de células yuxtaglomerulares Dear Editor: Juxtaglomerular cell tumor or reninoma is a benign, rare tumor located in the renal cortex and generally associated with high blood pressure (HBP) by hypersecretion of renin (primary hiperreninism). Macroscopically, they are usually lesions smaller than 3 cm located in the renal cortex, well circumscribed, and they should be considered in the differential diagnosis of HBP in young patients.1 We report the case of a 52-year-old woman with a history of hypercholesterolemia, HBP treated with atenolol, and frequent headaches. In the study of pain in the left renal flank that was treated primarily as muscular process, unresponsive to standard analgesia, there is urine sediment in which microhematuria is observed, and in the renal ultrasound, simple cysts are reported in the left kidney and small solid lesion suggestive of left renal angiomyolipoma. Given these findings, she was referred to our clinic. The physical examination did not evidence any signs of interest. CT was performed (Fig. 1) showing an hypodense nodule (−6 UH) and slightly uptaking cranial to the right 夽
Please cite this article as: Miján-Ortiz JL, et al. Tumor renal de células yuxtaglomerulares. Actas Urol Esp. 2013;37:61---2.
J.M. Cozar a,∗ , A. Huerta b , en representación del Comité Científico del estudio a Servicio de Urología, Hospital Universitario Virgen de las Nieves, Granada, Spain b Departamento de Evaluación de Medicamentos, División Científica, GlaxoSmithKline, Madrid, Spain ∗ Corresponding author. E-mail addresses: [email protected], donha [email protected] (J.M. Cozar).
kidney of about 2 cm × 3.5 cm which may correspond with adrenal adenoma, and with lower probability with renal angiomyolipoma, and it shows another 13-mm right posterior inferior renal nodule, slightly hyperdense and hypocaptating with respect to the renal parenchyma, suggesting tumor character (possible renal cell carcinoma, oncocytoma, etc.). We decided to study, by endocrinology, the possible adrenal hyperplasia, which indicates no treatment. For our part, given the suspected lesion of right renal tumor origin, we indicated laparoscopic lumpectomy that is performed on a scheduled basis. The patient did not have any incidence
Figure 1 CT showing right posterior inferior renal nodule of approximately 13 mm, slightly hyperdense and hypocaptating with respect to the renal parenchyma.
Actas Urológicas Españolas www.elsevier.es/actasuro
LETTERS TO THE EDITOR Care management of patients with benign prostatic hyperplasia in Spain夽 Manejo asistencial del paciente con hiperplasia benigna de próstata en Espa˜ na Dear Editor: Now more than ever, it is necessary to prioritize the use of more efficient resources by public institutions. In the field of health, we intend to achieve a quality healthcare, as well as an optimal use of the available resources to achieve the best treatment for the patients. As a result, the pharmacoeconomic analysis of different treatment options takes greater importance, especially for the chronic and most prevalent diseases, such as benign prostatic hyperplasia (BPH), as they involve higher cost for the system.1 Regarding the recently published study in this journal, Care management of patients with benign prostatic hyperplasia in Spain,1 which describes the actual management of patients with BPH, heterogeneity was observed in medical practice in primary care, which could generate inefficiency bubbles in the use of healthcare resources. It was therefore considered relevant to conduct further analysis, comparing the use of healthcare resources and the costs associated to the care management observed in this study to the use of resources and cost associated if expert recommendations’ criteria for referral in benign prostatic hyperplasia for priTable 1a
Costs of visits and tests performed of the different patterns observed per patient and year. Total costs
AP 1 AP 2 AP 3 AP 4 AP5 AP6 AP7 Criteria
mary care’ (criteria) were followed.2,3 To this end, on the basis of the patterns of care identified in the published study, and considering both the diagnosis and the follow-up of the disease, we calculated the annual cost/patient associated to each pattern, assigning to each resource used (diagnostic, follow-up tests, and medical visits) its unit cost (euros from 2012) obtained from published rates and multiplying by its frequency. Following the same methodology, we performed the quantification of the costs associated with the care management recommended in criteria. The variability in clinical practice results in variability in costs. Thus, the associated costs of the different patterns of care observed range from D 252.99 to D 1.250.74 per patient and year, while the costs associated to the care management recommended by criteria were between D 193.32 and 340.72 (Tables 1a and 1b). Based on these costs, if we had a fixed budget of D 100,000, adjusting for the frequency of each pattern and the prevalence of the clinical status of BPH, we could treat 237 patients/year, while criteria would make it possible to treat 471 patients/year. Therefore, the follow-up of criteria would enable to treat twice the number of patients a year by means of the care observed in the study. Therefore, the implementation of recommendations of experts could help achieve a more efficient use of the resources, without compromising the quality of patient care, achieving cost savings that could be redistributed and which could also reduce the variability in the treatment of patients.
D 666.78 D 546.96 D 1250.74 D 457.28 D 587.55 D 681.57 D 503.52 D 579.87
Cost of the visits
Cost of the test
D 72.31 D 72.31 D 83.97 D 69.98 D 74.64 D 69.98 NA D 88.44
D 146.48 D 108.50 D 147.80 D 111.93 D 111.92 D 51.49 NA D 37.70
Total cost of the diagnosis D 218.79 D 180.81 D 231.78 D 181.91 D 186.56 D 121.47 D 218.79 D 126.14
AP patterns 5, 6, 7 show no symptomatology difference; mild, moderate, and severe patients follow AP patterns 1 and 3; mild and moderate patients follow and severe ones refer AP patterns 2, 4 and Criteria; Mod.: moderate.
夽 Please cite this article as: Cózar JM, Huerta A, en representación del Comité Científico del estudio. Manejo asistencial de pacientes con hiperplasia benigna de próstata en Espa˜ na. Actas Urol Esp. 2013;37:60---1.
2173-5786/$ – see front matter © 2012 AEU. Published by Elsevier España, S.L. All rights reserved.
LETTERS TO THE EDITOR Table 1b
Costs of visits and tests performed of the different patterns observed per patient per year.
Mild AP 1 AP 2 AP 3 AP 4 AP5 AP6 AP7 Criterios
61
Cost of the visits
Cost of the tests
Total cost of the follow-up
Classification
Classification
Classification
Mod.
D 109.60 D 137.12 D 140.85 D 160.67
D 132.46 D 164.17 D 134.79 D 107.74
D 29.48
D 88.44
Severe D 166.97 D 153.45 D 90.25 D 65.53 D 118.93
Mild
Mod.
D 338.38 D 139.35 D 308.94 D 165.99
D 195.70 D 242.56 D 136.96 D 64.69
D 37.70
D 126.14
Severe D 864.97 D 194,65 D 145.91 D 65.99 D 489.26
Mild
Mod.
D 447.99 D 276.47 D 449.79 D 326.66
D 328.16 D 406.74 D 271.75 D 172.43
D 67.18
D 214.58
Severe D 1031.94 D 348.10 D 236.16 D 131.51 D 608.19
AP patterns 5, 6, 7 show no symptomatology difference; mild, moderate, and severe patients follow AP patterns 1 and 3; mild and moderate patients follow and severe ones refer AP patterns 2, 4 and Criteria; Mod.: moderate.
References 1. Cozar JM, Solsona E, Brenes F, Fernández-Pro A, León F, Molero JM, et al. Manejo asistencial del paciente con hiperplasia benigna de próstata en Espa˜ na. Actas Urol Esp. 2011;35:580---8. 2. Casti˜ neiras J, Cozar JM, Fernández-Pro A, Martín JM, Brenes FJ, Naval E, et al. Criterios de derivación en hiperplasia benigna de próstata para atención primaria. Actas Urol Esp. 2010;34:24---34. 3. Cozar JM, Casti˜ neiras J. Criterios de derivación de la hiperplasia benigna de próstata para atención primaria 2011. Versión 2011. Actas Urol Esp. 2012;36:203---4.
Renal juxtaglomerular cell tumor夽 Tumor renal de células yuxtaglomerulares Dear Editor: Juxtaglomerular cell tumor or reninoma is a benign, rare tumor located in the renal cortex and generally associated with high blood pressure (HBP) by hypersecretion of renin (primary hiperreninism). Macroscopically, they are usually lesions smaller than 3 cm located in the renal cortex, well circumscribed, and they should be considered in the differential diagnosis of HBP in young patients.1 We report the case of a 52-year-old woman with a history of hypercholesterolemia, HBP treated with atenolol, and frequent headaches. In the study of pain in the left renal flank that was treated primarily as muscular process, unresponsive to standard analgesia, there is urine sediment in which microhematuria is observed, and in the renal ultrasound, simple cysts are reported in the left kidney and small solid lesion suggestive of left renal angiomyolipoma. Given these findings, she was referred to our clinic. The physical examination did not evidence any signs of interest. CT was performed (Fig. 1) showing an hypodense nodule (−6 UH) and slightly uptaking cranial to the right 夽
Please cite this article as: Miján-Ortiz JL, et al. Tumor renal de células yuxtaglomerulares. Actas Urol Esp. 2013;37:61---2.
J.M. Cozar a,∗ , A. Huerta b , en representación del Comité Científico del estudio a Servicio de Urología, Hospital Universitario Virgen de las Nieves, Granada, Spain b Departamento de Evaluación de Medicamentos, División Científica, GlaxoSmithKline, Madrid, Spain ∗ Corresponding author. E-mail addresses: [email protected], donha [email protected] (J.M. Cozar).
kidney of about 2 cm × 3.5 cm which may correspond with adrenal adenoma, and with lower probability with renal angiomyolipoma, and it shows another 13-mm right posterior inferior renal nodule, slightly hyperdense and hypocaptating with respect to the renal parenchyma, suggesting tumor character (possible renal cell carcinoma, oncocytoma, etc.). We decided to study, by endocrinology, the possible adrenal hyperplasia, which indicates no treatment. For our part, given the suspected lesion of right renal tumor origin, we indicated laparoscopic lumpectomy that is performed on a scheduled basis. The patient did not have any incidence
Figure 1 CT showing right posterior inferior renal nodule of approximately 13 mm, slightly hyperdense and hypocaptating with respect to the renal parenchyma.