Cost-effectiveness analysis in health field and an application

In this study, it was aimed to demonstrate the cost and effectiveness of open and turp operations utilized in surgery treatment of benign prostate hyperplasia (BPH) using data mining methods and to compare the costs and effectiveness's by cost-effectiveness analysis which is very commonly used as an economic evaluation in the health field and to determine the cost-effective treatment from hospital perspective. It was determined that there were 86 male patients in total who had BPH in 2013 and all patients were included in the study. Patient files were checked and demographic, clinical, laboratory and hospital cost data of the patients were documented. Age, height (cm), weight (kg), type of surgery, presence of chronic disease, smoking status, duration of surgery (min), prostate specific antigen levels (PSA) (ng/mL), prostate weight (g), digital rectal examination (RT), length of hospital stay (days) and direct medical costs of hospital perspective (TL) were examined. Duration of hospitalization of the patients was addressed as effectiveness of the treatments. Mann Whitney U test was used for comparison of total cost between groups of the variables. Variables that affect the cost of the surgery types were determined using classification and regression trees (CART). These methods were used to draw the decision tree for BPH and the cost-effectiveness analysis was performed. According to total cost comparison between groups of variables, it was determined that old age, high PSA levels, long operation time, high prostate weight and hard prostate tissue increased the cost. In CART method, it was found that any of the variables affects the cost of open surgery while age, RT and duration of surgery affect the cost of turp surgery. According to the cost effectiveness analysis results, prevention cost of 1-day hospitalization was 177,28 TL/day in patients undergoing turp surgery and prevention cost of 1-day hospitalization was 987,12 TL/day in patients undergoing open surgery. It was concluded that turp surgery was a cost-effective treatment for the patients with BPH. Furthermore, the cost of elderly patients undergoing turp surgery with long operation time and cost of young patients who had soft tissue prostate was higher. Keywords: Benign prostate hyperplasia, cost effectiveness analysis, classification and regression trees