PMD27 Cost Comparison of Surgical Interventions to TREAT Lower Urinary TRACT Symptoms (LUTS) Secondary to Benign Prostatic Hyperplasia (BPH) in the UK, Sweden, and South Africa

Abstract

BPH is a common condition in ageing men that can negatively impact quality of life. Surgical management is indicated when medical management is no longer effective. We compared the overall cost and capacity benefit of available surgical interventions for the relief of LUTS in BPH in three countries considering the post-COVID19 “new normal”. A recently published Markov model developed from a UK NHS perspective and used in NICE MTG49 was adapted to the Swedish and South African healthcare perspectives. Patients entered the model having a surgical procedure before transitioning to one of four health states, defined by whether patients suffer from one, both or none of the long-term complications captured in the model, namely urinary incontinence or erectile dysfunction. Surgical retreatment, complications and procedure-related resource use was also considered. Surgical interventions included Water Vapor Thermal Therapy (WVTT), Photoselective Vaporization of the Prostate (PVP), Prostatic Urethral Lift (PUL), Holmium Laser Enucleation of the Prostate (HoLEP) and current standard of care, Transurethral Resection of the Prostate (TURP). Due to local practice differences, not all technologies were modelled in all geographies. In the UK, using a 4-year timeline, PVP and WVTT were associated with lowest costs (£2,421 and £2,466 respectively), followed by PUL (£2,994), TURP (£3,098) and HoLEP (£3,120). In Sweden, PVP was associated with lower costs (38,638kr) than TURP (39,801kr). In South Africa, WVTT was associated with lower costs (R58,882) than TURP (R82,939). WVTT, PUL and PVP had shorter procedure times (17.5-30, 30, 49.6 minutes, respectively) compared to TURP (66-90 minutes) and did not require hospitalization. Cost reductions were driven by shorter procedure durations and length of stay. WVTT and PVP were the joint lowest cost interventions over 4-years. Day-case procedures are of particular relevance in a post-COVID19 landscape.