Recent Trends in the Diagnostic and Surgical Management of Benign Prostatic Hyperplasia in the U.S. from 2004 to 2017: Annual Changes in the Selection of Treatment Options and Medical Costs
, Jin Kyu Oh 3,*,†, Satvir Basran 2, Edouard Nicaise 4, Phil Hyun Song 5, Wansuk Kim 6, Sang Youn Kim 7, Gyeong Eun Min 8, Koo Han Yoo 8, Hyuk Jin Cho 9, Sinyeong Lee 10, Alessandro Sciarra 1, Stefano Salciccia 1, Ettore De Berardinis 1, Vincenzo Asero 1, Carlo Maria Scornajenghi 1, Benjamin Pradere 11, Wojciech Krajewski 12, Andrea Gallioli 13, Matteo Ferro 14, Felice Crocetto 15, Savio Domenico Pandolfo 15,16, Federico Belladelli 2,17, Andrea Mari 18, Gian Maria Busetto 19, add
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Round 1
Reviewer 1 Report
Thank you for the opportunity to review the manuscript entitled ‘Recent trends in the diagnostic and surgical management of benign prostatic hyperplasia in the U.S. from 2004 to 2017: annual changes in the selection of treatment options and medical costs’.
The study is well written and presented, with appropriate methodology and reporting of results generally. The study will be of value relevant to the management and costs of BPH. However, there are some recommendations to be addressed provided below.
Methods
· Include a clearer inclusion and exclusion criteria, or summarise this in a table; this is important to be clearly shown
· Please be more specific on what methods were used to obtain a p-value for statistical analysis
Discussion
· Please provide discussion or explanation for the increasing age identified for males undergoing BPH treatment
Tables
· The tables need editing and formatting as they are very difficult to read
Author Response
Manuscript APPLSCI-1842509
REPLIES TO REVIEWERS:
Reviewer #1:
Thank you for the opportunity to review the manuscript entitled ‘Recent trends in the diagnostic and surgical management of benign prostatic hyperplasia in the U.S. from 2004 to 2017: annual changes in the selection of treatment options and medical costs’.
REPLY: We thank the reviewer for the kind comment and summary of this research study.
The study is well written and presented, with appropriate methodology and reporting of results generally. The study will be of value relevant to the management and costs of BPH. However, there are some recommendations to be addressed provided below.
Methods:
- Include a clearer inclusion and exclusion criteria, or summarise this in a table; this is important to be clearly shown
REPLY: we would readily agree with the reviewer’s comment. A summary of the inclusion criteria has now been included in the methods section to show the analytical steps which led to the final cohort composition.
- Please be more specific on what methods were used to obtain a p-value for statistical analysis
REPLY: we would thank the reviewer for her/his careful comment. No p-value has been utilized in the analysis which was mainly related to describe the temporal trends of the surgical and diagnostic procedures over time of enrollment without the existence of a group comparison. We therefore would like to thank the reviewer for helping us out to clarify this important aspect which has been now amended in the statistical paragraph accordingly.
Discussion
- Please provide discussion or explanation for the increasing age identified for males undergoing BPH treatment
REPLY: we would thank the reviewer for her/his suggestion. The discussion has been amended to reflect such insightful suggestion.
Tables
- The tables need editing and formatting as they are very difficult to read
REPLY: we would thank the reviewer for her/his suggestion. All tables within the manuscript have been amended to improve readability and visualization.
Reviewer 2 Report
The study is interesting, however, it presents several structural errors.
- "All Figures, Schemes and Tables should be inserted into the main text close to their first citation and must be numbered following their number of appearance (Figure 1, Scheme I, Figure 2, Scheme II, Table 1, etc.)." also they should be formatted according to the MDPI standards.
- The introduction should describe alternative methods to TURP more widely.
- Almost all references to the text are self-citations - maybe adding some data from other groups to the discussion would benefit the paper?
- The discussion should contain a comparison with data from other continents/countries.
- The authors did not include the obligatory section about author contributions nor about the founding, which should be highlighted when the manuscript contains 29 authors and presents results which may be sensitive in case of conflict of interest.
I think the paper should be improved, because it may impact urology, but its present form is not recommended for publication.
Author Response
Manuscript APPLSCI-1842509
REPLIES TO REVIEWERS:
Reviewer #2:
The study is interesting; however, it presents several structural errors. "All Figures, Schemes and Tables should be inserted into the main text close to their first citation and must be numbered following their number of appearance (Figure 1, Scheme I, Figure 2, Scheme II, Table 1, etc.)." also they should be formatted according to the MDPI standards.
REPLY: we would readily thank the reviewer for her/his careful comment. The text has now been amended to reflect such structural change and all figures and tables have now been reordered following the suggested MPDI methodology of reporting.
The introduction should describe alternative methods to TURP more widely.
REPLY: the text has been amended to expand the introduction section on alternative TURP approaches.
Almost all references to the text are self-citations - maybe adding some data from other groups to the discussion would benefit the paper?
REPLY: self-citations presented in the document are mainly related to the previous validation investigation and studies which derive from the specific Optum deidentified Clinformatics® Claims Database. This has been previously done for other series and rely also on the justification for exempt from informed consent requirements. Nevertheless, we would gladly accept the reviewer’s critique and we have removed some of these citations while briefly commenting and referencing different series.
The discussion should contain a comparison with data from other continents/countries.
REPLY: the text has been amended to expand the discussion section on the comparison between different continents and/or countries.
The authors did not include the obligatory section about author contributions nor about the founding, which should be highlighted when the manuscript contains 29 authors and presents results which may be sensitive in case of conflict of interest.
REPLY: we would thank the reviewer for such careful comment. This section has now been included in the main document including all the aforementioned sections.
I think the paper should be improved, because it may impact urology, but its present form is not recommended for publication.
REPLY: We thank the reviewer for the kind comment and summary of this research study. We submit the updated version of the present manuscript which we retain a much-improved argument after the reviewer’s suggestions.
Reviewer 3 Report
The aim of the study was to present the annual rates of BPH surgery and to analyze recent trends in the surgical management of the disease, with special attention paid to medical costs.
Although the analysis would be truly beneficial for healthcare providers worldwide, it lacks many aspects which makes the presented data inconclusive. Furthermore, I found the presentation of the data too simplified with several limitations that were not mentioned or sufficiently discussed.
Some inclusion criteria were areguable, i.e. over 50 year-old males, TURPis not included.
Author Response
Manuscript APPLSCI-1842509
REPLIES TO REVIEWERS:
Reviewer #3:
The aim of the study was to present the annual rates of BPH surgery and to analyze recent trends in the surgical management of the disease, with special attention paid to medical costs.
Although the analysis would be truly beneficial for healthcare providers worldwide, it lacks many aspects which makes the presented data inconclusive. Furthermore, I found the presentation of the data too simplified with several limitations that were not mentioned or sufficiently discussed.
REPLY: we would thank the reviewer for her/his comment. The article has now undergone a deep review and major limitations have been addressed in the text to improve the overall article quality. The results section and data presentation have now been expanded to improve the readability of the document. Discussion section has also been expanded to improve the previously available series on this topic.
Some inclusion criteria were areguable, i.e. over 50 year-old males, TURPis not included.
REPLY: We thank the reviewer for the kind comment and summary of this research study. A new summarizing figure visually depicting all inclusion and exclusion criteria have been now added in the supplementary files to analytically report each step of the final cohort composition.
Round 2
Reviewer 2 Report
The Authors have addressed almost all my concerns, the only drawback of the manuscript which I detect is that the captures for the figures and tables should be attached by them and not below the whole body of the paper. If this aspect will be included, I won’t have any more objections against the paper.
Author Response
The Authors have addressed almost all my concerns, the only drawback of the manuscript which I detect is that the captures for the figures and tables should be attached by them and not below the whole body of the paper. If this aspect will be included, I won’t have any more objections against the paper.
REPLY: we thank the reviewer for her/his comment. The text has now been amended to reflect all the requested edits. We thank the reviewer for her/his valuable work.
Reviewer 3 Report
I would like to thank the authors for their comments and response.
Author Response
I would like to thank the authors for their comments and response.
REPLY: we thank the reviewer for her/his work on our manuscript.
