[Show abstract][Hide abstract] ABSTRACT: Abstract:
Green light photo selective vaporization of the prostate (PVP) is a
minimally invasive method of treatment for clinical benign prostatic hyperplasia with
fewer side effects. The aim of this study is to evaluate the safety, effectiveness and
cost analysis of PVP compared with transurethral resection of prostate.
A systematic search was done in Cochrane, TRIP database, MEDLINE,
NHS EED, NIHR HTA, CRD, Health star database, Pro Quest, Psycoinfo and Google
Scholar to find randomized control trials, systematic reviews and HTA reports. The
searched keywords were Green light laser (PVP or KTP) and prostate. The cost
analysis was done by the perspective of society and providers.
Complication rate in 12 included evidences ranged from 0-9.3%. The
complication rate of TUR-P (Transurethral Resection of Prostate) was more than
PVP. Changing in flow rate reducing residual urine, improving patients’ symptoms
and QOL (Quality of life), and operative outcome length of operation varied from no
significant to significant differences in favor of TURP. Unit cost in both social and
provider view was significantly high in PVP in comparison with TURP. Increasing
the number of patients did not change the cost analysis.
PVP is a safe method for treatment of clinical BPH, but there is a lack
of evidence for the evaluation of effectiveness. Overall, the unit cost for PVP was
significantly more than TURP; for this reason this method could not be conducted
in very wide indications, because of high cost.
laser vaporization; ablation techniques; health technology assessment;
benign prostatic hyperplasia.
Journal of Lasers in Medical Sciences 10/2012; 2(4):153.
[Show abstract][Hide abstract] ABSTRACT: Introduction: Our aim was to compare the cost effectiveness of holmium laser prostate enucleation (HOLEP) versus trans-urethral resection of prostate. Materials and Methods: We searched all available databases for any controlled trials comparing HOLEP and TURP from January 2000 to February 2009. Two independent reviewers studied and appraised the selected evidences. Then, effectiveness and cost effectiveness of HOLEP was evaluated. Results: We identified four randomized controlled trials and one systematic review according to the inclusion criteria. Most of the studies had moderate quality of evidence with limited sample sizes. Overall success rate of HOLEP was comparable with TURP; but, some secondary outcomes such as pick flow rate twelve months after the surgery was better in HOLEP. A comparison between the original costs and those obtained from sensitivity analysis showed that the cost parameters were sensitive to the number of the patients treated. Increasing the number of the patients from 200 to 300 changed the study's results in favor of the new techniques. Conclusion: Since the holmium and thulium laser sets are sensitive to the number of the patients and multipurpose, they potentially can be applied for stone fragmentation. Thus, utilization of these equipments will divide the costs between two groups of the services. In economic terms, these properties lower overhead costs and justify the purchasing of these equipments.
[Show abstract][Hide abstract] ABSTRACT: Abstract:
To compare the efficacy and cost-effectiveness of Femtosecond laser
versus mechanical Microkeratome corneal flap creation in correction of refractive errors.
In this review, a comprehensive search of Medline, SCOPUS, Cochrane,
TRIP database, supplemented by HTA and economic databases was performed. We
searched for randomized controlled trials (RCTs) of Femtosecond laser which included
mechanical Microkeratome in other arm. The quality of the retrieved studies was
appraised by two independent reviewers and appropriate articles were finalized.
A total of 1142 articles were identified, of which, 1059 were excluded after
review of the titles and abstracts and 83 articles remained. Systematic reviews and
RCTs were evaluated through CASP international worksheet. Eventually, 61 titles
were excluded, leaving 22 articles to be reviewed.
There was no individual evidence to cover all safety components about
Femtosecond laser, but in summary, this modality seems a safe method for corneal
No statistically significant difference was shown in visual acuity
and refractive errors. The important secondary end point of this review was diffuse
Lamellar keratitis in 17% of the Femtosecond group versus 5% in mechanical
Microkeratome. Inflammation was low-grade and improved during the first 3 months
of follow-up period with a low dose medication without corneal scarring. The two
groups was comparable in all clinical outcomes including Unorrected Visual Acuity
(UCVA), Best Special Corrected Visual Acuity (BSCVA), manifest refraction, wave
front aberrometry, Schirmer test, and Tear Break up time (TBUT).
: Results showed that marginal cost incurred due to Femtosecond
technology adoption may vary from 27 to 117 € (resulted from sensitivity analysis). It
is clear that additional cost may be a small proportion of LASIK procedure total cost.
Although Femtosecond flap creation is a modern method with a good
quality of corneal flap, but, there is no high-quality evidence to show superiority
of Femtosecond laser in clinical outcomes. Although the efficacy and cost of the
systems is almost equal, traditional method still remains as the standard approach.
Lasers; Keratomileusis, Laser In Situ; Laser Therapy; Cost Analysis;
Journal of Lasers in Medical Sciences 11/2011; 2(1):6-11.
[Show abstract][Hide abstract] ABSTRACT: The quality of the evidence is a keystone in the understanding of Evidence Based Medicine. Randomized controlled trials (RCTs) rank first among the research designs providing clinical evidence. Knowing about the design of clinical trials is not only the cornerstone of clinical research, but also is a requirement for any clinician who wants to learn about new findings of clinical research in his/her field. Many clinicians have good understanding as well as some misunderstandings about the design of clinical trials. This article is going to provide some crucial comments to be considered in conducting RCTs in order to help in production of better evidence for future of urology research through RCTs.
Indian Journal of Urology 10/2011; 27(4):494-7. DOI:10.4103/0970-1591.91440
[Show abstract][Hide abstract] ABSTRACT: The goal of this article is to help develop, disseminate, and evaluate resources that can be used to practice and teach EBM for urology residents and continuing education of urologists to reduce the gap between research and clinical practice. Urology departments should build capacity for residents to shape the future of quality and safety in healthcare through translating evidence into practice. Cutting edge approaches require knowing how to teach Evidence-based urology, to make Bio-statistics easy to understanding and how to lead improvement at every level. The authors shared their experience about 'what works' in a surgical department to building an Evidence-based environment and high quality of cares.
Indian Journal of Urology 10/2011; 27(4):490-3. DOI:10.4103/0970-1591.91439