963 Holmium laser enucleation of the prostate versus open prostatectomy: A prospective cost analysis

Abstract

INTRODUCTION AND OBJECTIVES: Holmium laser enucleation of the prostate (HoLEP) has emerged as an ideal alternative to open surgery. Short-term results demonstrate minimal morbidity making it safe for patients with prostates of any size, leading to a decrease in hospital stay. Long-term results demonstrate low rate of complications with very few patients needing subsequent procedures. METHODS: From Jan 2012 to Oct 2014 a total of 83 equivalent patients with large prostate (65 to 300 g) and documented BOO underwent surgical treatment with either OP (40 in group 1) or HoLEP (43 in group 2 and 3). All costs associated with the procedures during the hospital stay and at least 1 year follow up including routine office visits and management of complications were assessed prospectively. A cost analysis of each individual clinical event was performed. RESULTS: Three groups were set up for the cost analysis. Group 1 for OP, group 2 for HoLEP in a pay per patient rent regime (HoLEP RR), and group 3 for HoLEP in a 7 year amortization purchase program (HoLEP PP). The cost analysis showed a mean cost of 4.326 Euros for group 1; 3.843 Euros for group 2 and 2.589 Euros for group 3. (Full results are displayed in table 1) Hospitalization for HoLEP was 4,4 times cheaper than OP, and the complication costs were 92% less in the HoLEP group. CONCLUSIONS: HoLEP is associated with a significant net cost saving compared with OP, in patients undergoing surgery for symptomatic benign prostatic hyperplasia in large glands, especially in a long term purchase program.