A cost-effectiveness analysis of pharmacotherapy versus prostatic urethral lift as initial therapy for patients with moderate benign prostatic hyperplasia

Abstract

ABSTRACT Aim The objective of this study was to evaluate the cost-effectiveness of an upfront minimally invasive surgical procedure, the prostatic urethral lift (PUL), as an initial treatment for patients with moderate benign prostatic hyperplasia (BPH), against current first-line pharmacotherapy with combination medical therapy. Method A micro-simulation model was developed using TreeAge Pro to compare two treatment strategies – initial treatment with combination medical therapy (alpha-blocker + 5-ARI) versus an upfront prostatic urethral lift procedure. The impact on disease progression, costs, and quality-adjusted life-years (QALYs) was analyzed. A Markov model and probabilistic sensitivity analysis were used to estimate the costs and effects of the different strategies. The cost-effectiveness of the strategies at different willingness-to-pay (WTP) thresholds was then examined. Results Incremental costs (versus no prostatic urethral lift) were S$13,600 (1 year) and S$8,700 (5 years). Incremental QALYs were 0.07 (1 year) and 0.22 (5 years). An upfront PUL procedure was more expensive but also more effective than pharmacotherapy, with an incremental cost per QALY gain of approximately S$39,400. It is a cost-effective treatment option at the willingness-to-pay threshold of S$50,000. Conclusion Prostatic urethral lift is a cost-effective initial treatment option for men with moderate symptoms of benign prostatic hyperplasia.