Evaluation of Private Payer and Patient Out-of-Pocket Costs Associated With the Surgical Management of Benign Prostatic Hyperplasia

Abstract

ObjectivesTo evaulate and compare the financial burden of various surgical interventions for the management of benign prostatic hyperplasia (BPH). MethodsWe identified commercially insured men with a diagnosis of BPH who underwent a procedure of interest (SP, TURP, HoLEP, PVP, PUL, or WVTT) between 2015-2021 with the OptumLabs Data Warehouse. Primary outcome was total healthcare costs (THC) which included both patient out-of-pocket (OOP) and health plan paid (HPP) costs for the index procedure and combined follow-up years 1-5. A generalized linear model was used to estimate adjusted costs controlling for demographic and clinical characteristics. Patients undergoing WVTT were excluded from extended follow-up analyses due to limited data. ResultsAmong 25,407 patients with BPH, 10,117 (40%) underwent TURP, 6,353 (25%) underwent PUL, 5,411 (21%) underwent PVP, 1,319 (5%) underwent SP, 1,243 (5%) underwent WVTT, and 964 (4%) underwent HoLEP. Index procedure costs varied significantly with WVTT being the least costly [THC: $2,637 (95% CI: $2,513 – $2,761)], and SP being the costliest [THC: $14,423 (95% CI: $12,772 – $16,075)]. For aggregate index and 5-year follow-up costs, HoLEP ($31,926 [95% CI: $29,704–$34,148]) was the least costly and PUL ($36,596 [95% CI: $35,369-37,823]) was the costliest. ConclusionsBPH surgical treatment is associated with significant system-level healthcare costs. The level of impact varies between procedures. Minimally invasive options, such as WVTT, may offer initial cost reductions; however, HoLEP and SP are associated with lower follow-up costs.