Scientific journal
European Journal of Natural History
ISSN 2073-4972

Pharmacological analysis of tactics of operative treatment of an innocent hyperplasia of prostate

Sevryukov F.A., Kaliniskaya A.A.

In case of presence of evidence for operative treatment of an IHP, transurethral resection of prostate (TRP) is considered to be a «golden standard» for the standard volume of prostate up to 80 cm3.

Our objective was to define the applicability of alternatives for unipolar TRP (UTRP), specifically, bipolar transurethral resection and transurethral bipolar plasmatic vaporization of prostate for a small volume of prostate.

Comparative analysis of the results of unipolar and bipolar transurethral resection for an average volume of prostate shows the advantage of BTRP in the majority of significant indicators (complication frequency, bed fund work indicators), insignificantly less time of operation was the only advantage of UTRP.

Totally 167 patients with prostate volume of up to 80 cm3 were studied within the research.

Open surgery - adenomectomy was implemented for patients with a prostate of bigger volume. Transurethral enucleation of prostate with bipolar loop - Trans Urethral Enucleation with Bipolar (TUEB) is an alternative method of choice. We have carried out an analysis of its clinical advantages (minimal blood loss during an operation, short period of placement urethral catheter in urinary tracts (24-72 hours), lack of traumatic cut of the front abdominal wall and urinary bladder, quick normalization of urine composition, short recovery and restoration of workability of patients [6, 7]) and economic effect for persons of capable and incapable age. Selection volume equaled: 122 patients for the method of transurethral enucliation and 122 patients for the method of adenomectomy.

Economic efficiency is a result of the achieved positive medical and social effect. A decrease in morbidity with temporal loss of workability (TLW) cuts down economic losses and thus defines an economic effect. An effect (E) is a difference between economic losses (damage) (ED) in a basis period or within basis conditions (Bc) and losses in a given (calculative) period or in real conditions (Rc).

ED = Bc - Rc.

Calculation of economic effect of improving quality of preservation and opportune qualitative treatment of men based on defining decrease in economic losses (damage) of a country as a result of decrease in morbidity with TLW. According to the method, suggested by E.N. Kulagina in 1995, 1998, 2001, a damage is calculated by formula:

DAMAGE = [(D·Tk) + (B·Tk) + (L·Tk)]·Р,

where D is GDP, produced in average per one working person per one business day; B is an average sum of benefits for temporal disability from the funds of social insurance for one day of temporal disability; L is treatment costs per one patient (stationary, ambulatory, and other kinds of medical help) from the budget funds and funds of Obligatory Medical Insurance, calculated per
1 calendar day of TLW; Tk is the duration of temporal disability per one working person in calendar days; P is a number of patients among workers of
an economy.

Tariffs of medical services for grown population in accordance with N. Novgorod programme of obligatory medical insurance in 2011. Costs are presented in rubles. All numeral data represent average values.

1. Economic effect of using bipolar vaporization before BTRP under prostate adenoma up to 40 cm3.

Hierarchic cluster analysis of the duration of post-surgery period (bed-days after a surgery) was used as a clinical component of the research.

Economic damage was defined for bipolar vaporization and BTRP for persons of capable and incapable age (table 1).

Table 1 Economic damage with usage of bipolar vaporization and BTRP for persons of capable and incapable age, rubles.

Capable age

Incapable age

Costs

Bipolar vaporization

BTRp

Bed/day

4,6

5,9

Cost of b/d

3941,326

5055,179

General study

610,05

610,05

Special study

1820,4

1820,4

Treatment

21000

26500

Total

27371,776

33985,629

Ed of TD

5797,38

7435,77

Total

33169,16

41421,4

ED of TD for 2011 under implementation of bipolar vaporization = [(806,5 + 453,8)·4,6] = 5797,4 rubles. Total costs under stationary treatment and implementation of BTRP equaled 27371,8 rubles for the unemployed and 33169,2 for the employed.

Economic effect (a difference between total damages of BTRP and bipolar vaporization for incapable age equaled 6613,9 rubles, and for capable age it equaled 8252,2 rubles.

2. Economic effect of implementation of unipolar and bipolar transurethral resection.

Economic damage was also calculates for persons of capable and incapable age (Table 2).

ED of TD in 2011 under implementation BTRP = [(806,5 + 453,8)·6,4] = 8065,92 rubles. Total costs of under stationary treatment and implementation of BTRP equaled 34414 rubles for the unemployed and 42480 for the employed.

Ed of TD in 2011 under implementation of UTRP = [(806,5 + 453,8)·7,8] = 9830,3 rubles. For UTRP total costs equaled 35113,6 rubles for the unemployed and 44943,9 for the employed.

For incapable age economic effect (difference between total costs for using MTRP and UTRP) equaled 699,5 rubles, for persons of capable age it equaled 2464 rubles.

3. Economic effect of using bipolar vaporization before BTRP.

Economic effect of using TUEB before open adenomectomy was calculated as a difference of economic damage (Table 3).

ED of TD for 2011 under implementation of TUEB = [(806,5 + 453,8)·5,6] = 7057,7 rubles. Total costs under stationary treatment and using TUEB equaled 37288,6 rubles for the unemployed and 44286,3 rubles for the employed.

Table 2 Economic damage under implementation of BTRP and UTRP for persons of capable and incapable age, rubles

Capable age

Incapable age

Costs

BTRP

UTRP

Bed/day

6,4

7,8

Cost of b/d

5483,584

6683,118

General study

610,05

610,05

Special study

1820,4

1820,4

Treatment

26500

26000

Total

34414,034

35113,568

Ed of TD

 

9830,34

Total

 

44943,91

Table 3 Economic damage under implementation of TUEB and open edanomectomy for persons of capable and incapable age, rubles

Capable age

Incapable age

Costs

TUEB

Open adenomectomy

Bed/day

5,6

13,7

Cost of b/d

4798,136

11738,297

General study

610,05

610,05

Special study

1820,4

1820,4

Treatment

30000

13000

Total

37228,586

27168,747

Ed of TD

 

17266,11

Total

 

44434,86

Ed of TD in 2011 under implementation of open adenomectomy = [(806,5 + 453,8)·13,7] = 17266,11 rubles. For open adenomectomy total costs equaled 27168,7 rubles for the unemployed and 44434,9 for the employed.

For persons of incapable age we have revealed a negative economic effect (difference between total losses of implementation of open adenomectomy and TUEB), that equaled 10059,8 rubles. For persons of incapable age economic effect was practically equal to 148,6 rubles.

Thus, the economic effect has confirmed implementation of bipolar vaporization for adenoma of small size (up to 40 cm3) and BTRP for adenoma of average size (40-80 cm3).

Regardless of negative economic effect of treating adenoma of bigger size (over 80 cm3) under implementation of TUEB for persons of elderly age and equal economic effect for employed men, implementation of this very method is reasonable due to its expressed positive medical-social efficiency (based on clinical component).

It is necessary to evaluate not only clinical efficiency and safety, but also the economic component of cure while selecting treatment tactics in modern terms. Choosing tactics of operative treatment under innocent hyperplasia of prostate is generally defined by the volume of a prostate itself. Economic effect was calculated for persons of capable and incapable age. We have defined an economic effect of implementation of bipolar vaporization for adenoma of small size, BTRP for adenoma of average size, and, within complex evaluation of medical-social efficiency and economic effect, for adenoma of bigger size - implementation of TUEB.

References

  1. Izmailov R.I. Optimization of treating patients with innocent hyperplasia of prostate of bigger size: author´s abstract of dissertation, candidate of medical science. - Saratov, 2010.
  2. Lopatkin N.A. Urology: clinical recommendations. - Moscow, 2007. - 352 p.
  3. Zhdanova S.N. Methodical problems of defining economic efficiency of using new medical equipment and/or new medical preparation // Dissertation for candidate of economic science. - Moscow, 2003. - 150 p.

The work is submitted to the Scientific International Conference «Research on the priority of higher education on-directions of science and technology», on board the cruise ship MSC Musica, Italy-Greece-Croatia-Italy, June, 10-17, 2012, came to the editorial office оn 17.05.2012.