Health-related quality of life and patient-reported outcome measures in economic evaluation of urological technologies: challenges and opportunities

Abstract

Objective

To examine the role of health-related quality of life (HRQoL) assessments and patient-reported outcome measures (PROMs) in the economic evaluation of urological interventions, highlighting methodological challenges, and identifying areas for future development.

Methods

This narrative review synthesises key frameworks for economic evaluation in urology, describes methods for utility derivation, and critically appraises the application of both generic and disease-specific PROMs. Evidence is drawn from major urological trials and model-based evaluations, with attention to their impact on health technology assessment decisions.

Results

Patient-reported outcome measures underpin cost-utility analyses across the full spectrum of urological conditions, including benign prostatic hyperplasia (BPH), urinary incontinence, overactive bladder, bladder cancer, renal cancer, and prostate cancer. Generic instruments such as the EuroQoL five Dimensions (EQ-5D) and 36-item Short-Form Health Survey (SF-36) facilitate cross-disease comparison but may lack sensitivity to urological symptoms. Disease-specific tools (e.g., International Prostate Symptom Score, Overactive Bladder Questionnaire, 26-item Expanded Prostate cancer Index Composite) provide granularity but often require mapping to utility values, introducing uncertainty. Trial-based evaluations (e.g., Trans European Research into the use of Management Policies for LUTS suggestive of BPH in Primary Healthcare [TRIUMPH], Single-Incision Mini-Slings [SIMS], Refractory Overactive Bladder: Sacral NEuromodulation vs BoTulinum Toxin Assessment [ROSETTA]) demonstrate that PROM-derived quality-adjusted life year differences can decisively influence cost-effectiveness. Surgery-related PROMs including the Consultation and Relational Empathy measure can capture important short-term recovery outcomes not measured by generic tools.

Conclusions

Health-related quality of life and PROMs are foundational to value-based urological care. Accurate and context-sensitive measurement ensures that cost-utility analyses reflect patient experience as well as clinical outcomes. Future priorities include development of preference-based urology-specific PROMs, improved digital/electronic PROM capture, validation of mapping algorithms, and integration of surgery-related PROMs into economic evaluations.