Paclitaxel-Coated Balloon Dilation for Adults With Recurrent Bulbar Urethral Stricture: A Health Technology...

Area of Science:

• Urology
• Health Technology Assessment
• Health Economics

Background:

• Bulbar urethral stricture, a narrowing of the urethra, causes voiding difficulties and requires effective treatment.
• Surgical urethroplasty is the gold standard, but minimally invasive options like balloon dilation are used for recurrent cases.
• Paclitaxel-coated balloon dilation is a second-line treatment option for recurrent bulbar urethral strictures.

Purpose of the Study:

• To assess the safety, efficacy, and cost-effectiveness of paclitaxel-coated balloon dilation for recurrent bulbar urethral stricture in adults.
• To evaluate the budget impact of publicly funding this technology in Ontario.
• To understand patient experiences and preferences regarding treatment options.

Main Methods:

• Systematic literature search for clinical and economic evidence.
• Development of a Markov model for cost-effectiveness analysis from a public payer perspective.
• Analysis of the 5-year budget impact and qualitative data from patient interviews.

Main Results:

• Limited direct comparative evidence exists; one trial (ROBUST III) showed potential benefit in freedom from reintervention, though with limitations.
• Paclitaxel-coated balloon dilation may improve urinary symptoms and flow, with no impact on sexual function, but increased short-term hematuria and dysuria.
• Economic modeling suggests potential cost savings (approx. -$1,476 per person) and increased effectiveness over 5 years compared to usual care.
• Budget impact analysis estimates potential savings of $0.74 million over 5 years in Ontario.
• Patients view the procedure favorably due to its minimally invasive nature, but face access barriers like cost and awareness.

Conclusions:

• Paclitaxel-coated balloon dilation may be a more effective and cost-saving option for recurrent bulbar urethral strictures, though evidence quality is low.
• Public funding in Ontario could lead to significant cost savings, but results require cautious interpretation due to evidence limitations.
• Patient preference for minimally invasive procedures is high, but access barriers need to be addressed.