The appropriateness of treatment of benign prostatic hyperplasia: a comparison of Dutch and multinational criteria

Over the last decade, a number of organisations have developed clinical gui delines, typically at a national level, in order to increase appropriate he alth care. This raises the question as to whether it is possible to develop guidelines, applicable on the national level, at an international level. I n order to examine this, we compared the appropriateness criteria for the t reatment of benign prostatic hyperplasia ratings developed by two panels, o ne a single-nationality (Dutch) panel. the other a multinational (European) panel. The panels, both consisting of experienced urologists, used a modif ied Delphi process to rate 1152 indications for the most common treatments (surgery, alpha -blocker, finasteride and watchful waiting) on a nine-point scale. This article describes the similarities and differences between the ratings produced by the panels. The appropriateness ratings were identical for 84% of the indications (kappa = 0.76). The difference in the scores fo r individual indications was zero in 41% of indications and less than or eq ual to two in 99% of indications. This study provides strong evidence that a multinational panel can deliver essentially the same appropriateness rati ngs for BPH as a national panel. Developing appropriateness criteria on an international level may result in significant savings and may help contribu te to the reduction of undesirable practice variation. (C) 2001 Elsevier Sc ience Ireland Ltd. All rights reserved.