Choosing the Right BPH Procedure: Evaluating Patient Priorities and the Impact of Cost on BPH Surgical Preference - PROJECT SUMMARY/ABSTRACT Problem To Be Addressed The large number of surgical management options for BPH can be overwhelming for patients and providers alike. To better understand the factors that impact patient uptake of surgical treatment for BPH, it is important to understand specific patient preferences, including attitudes regarding cost. Specific Aims and Experimental Design Aim 1: Identify the peri-operative factors most important to patients undergoing BPH surgical intervention. Aim 2: Quantify patient priorities surrounding BPH surgical intervention. Aim 3: Assess the relative importance of cost for patients undergoing BPH surgical intervention. Beginning with an ongoing study utilizing validated questionnaires (EQ-5D-5L, OAB-5D, COST-FACIT, and patient preference ranking) provided to 150 patients undergoing BPH surgery, we will identify the factors (e.g. procedure location, indwelling urethral catheter duration, risk of urinary incontinence, and retreatment rate) most important to patients (Aim 1). These factors will inform the construction of a subsequent discrete choice experiment (DCE) survey. Patients will be asked to choose among multiple choice tasks that can quantify the trade-offs for positive and negative attributes for hypothetical BPH surgical interventions (e.g., lower risk of short-term incontinence but higher risk of need for retreatment). In addition to the factors identified on the initial survey study, a range of costs will be included to ascertain willingness-to-pay (WTP) thresholds for the various attributes prioritized by patients. The DCE will be prospectively administered online to 200 patients undergoing evaluation of BPH within the urology clinic. Each patient will value 10 to 15 choice tasks. Econometric analysis will be performed to identify preference weights, overall attribute importance, attribute equivalence for each factor included, and WTP estimates (Aims 2 & 3). These data will serve as the first quantifiable measure of preferences for patients undergoing BPH surgery. Findings from this study will serve as a foundation for subsequent patient and provider decision aid tools. Career Goals and Development Through work with a multidisciplinary mentorship team at Mayo Clinic, the candidate will gain knowledge and skills needed for survey-based research, qualitative analysis, DCE methodology, and shared decision-making tool creation for BPH and other benign urologic conditions.
