Endoscopic Urethrotomy Vs Open Urethroplasty for Men With Bulbar Urethral Stricture: The Open Randomised Trial CostEffectiveness Analysis

Jing Shen, Luke Vale* (Corresponding Author), Beatriz Goulao, Paul Whybrow, Stephen Payne, Nick Watkin

*Corresponding author for this work

Research output: Contribution to journalArticlepeer-review

Abstract

Background: Bulbar urethral stricture is a common cause for urinary symptoms in men and its two main treatment options both have drawbacks with little evidence on their relative cost-effectiveness. Current guidelines on the management of recurrent bulbar urethral stricture have been predominantly based on expert opinion and panel consensus.
Objective: To assess the relative cost-effectiveness of open urethroplasty and endoscopic urethrotomy as treatment for recurrent urethral stricture in men.
Methods: Set in the UK National Health Service with recruitment from 38 hospital sites, a randomised controlled trial of open urethroplasty and endoscopic urethrotomy with 6-monthly follow-up over 24 months was conducted. Two hundred and twentytwo men requiring operative treatment for recurrence of bulbar urethral stricture and having had at least one previous intervention for stricture were recruited. Effectiveness was measured by quality- adjusted life years (QALYs) derived from EQ-5D 5L. Cost-effectiveness was measured by the incremental cost per QALY gained over 24 months using a within trial analysis and a Markov model with a 10-year time horizon.
Results: In the within trial, urethroplasty cost on average more than urethrotomy (cost difference: £2148 [95% CI: 689, 3606]) and resulted in a similar number of QALYs on average (QALY difference: -0.01 [95% CI: -0.17, 0.14)] over 24 months. The Markov model produced similar results. Sensitivity analyses using multiple imputation, suggested that the results were robust, despite observed missing data.
Conclusions: Based on current practice and evidence, urethrotomy is a cost-effective treatment compared with urethroplasty
Original languageEnglish
Number of pages13
JournalBMC Urology
DOIs
Publication statusAccepted/In press - 8 Feb 2021

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