The following is a summary of “Evaluation of the Cost-Effectiveness of Surgical Treatment Options for Benign Prostatic Hyperplasia,” published in the JANUARY 2023 issue of Urology by Wymer, et al.

For a study, researchers sought to conduct a cost-utility analysis comparing the cost-effectiveness of four surgical interventions for benign prostatic hyperplasia (BPH) using a Markov model. 

The four interventions considered were Holmium laser enucleation of the prostate (HoLEP), bipolar transurethral resection of the prostate (B-TURP), water vapor thermal therapy (WVTT), and prostatic urethral lift (PUL) for prostate sizes <80cc (index patient 1), and HoLEP and simple prostatectomy (SP) for prostate sizes >80cc (index patient 2). The model probabilities and utility values were obtained from the literature, and the analysis was performed over a 5-year time horizon with extrapolation to a lifetime horizon. The primary outcomes assessed were quality-adjusted life years (QALYs), 2021 Medicare costs, and incremental cost-effectiveness ratios (ICERs) using a willingness-to-pay threshold of $100,000/QALY. The study also conducted univariate and probabilistic sensitivity analyses.

The results indicated that, after 5 years, the costs per patient for index patient 1 were $3,292 (WVTT), $6,532 (HoLEP), $6,670 (B-TURP), and $10,257 (PUL). HoLEP resulted in the highest QALYs (4.66), followed by B-TURP (4.60), PUL (4.38), and WVTT (4.38). Consequently, HoLEP has been deemed the most cost-effective intervention (ICER $11,847). For index patient 2, HoLEP was less costly ($6,585 vs $15,404) and more effective (4.654 vs 4.650) compared to SP. The sensitivity analysis for index patient 1 showed that B-TURP became the most cost-effective intervention if the cost of HoLEP increased two-fold or chronic stress incontinence following HoLEP increased ten-fold. Additionally, the analysis found that WVTT was the preferred intervention at very short follow-up times (<1 year), but HoLEP became more strongly preferred with longer follow-up times.

Therefore, the study concluded that, after 5 years of follow-up, HoLEP was the most cost-effective surgical treatment for BPH, regardless of the gland size.

Reference: goldjournal.net/article/S0090-4295(22)00881-0/fulltext