PUK20 - Comparison of Costs Associated with Turp and Prostatic Urethral Lift for Benign Prostatic Hyperplasia

Abstract

To compare outcomes and costs associated with treatment of benign prostatic hyperplasia (BPH) by monopolar or bipolar transurethral resection of the prostate (TURP) or prostatic urethral lift (PUL). We searched the literature for reports on PUL (from 2010 onwards) and TURP, and were allowed access to the National Health Service Hospital Episode Statistics (HES) database (Copyright NHS Digital 2018) and The Health Improvement Network (THIN) to search at the record level for hospitalisation and treatment rates for TURP in England, from January 2009/10 onwards. In 2016/17, 18,362 TURP procedures were performed. The mean procedure cost was £2,869 (IQR £2,422–3,138; total ~£43 million) and the average hospital stay was 2.7 days. Complications of TURP include ejaculatory dysfunction (≥65%), erectile dysfunction (10%), urethral stricture (4%), infection (4%), bleeding requiring transfusion (2%), and urinary incontinence (2%). Around 20% of patients restart drug therapy for lower urinary tract symptoms (LUTS) within 3 years. Among all recipients of TURP for BPH in 2009/10, cumulative HES data to 2014/15 showed 70,000 post-procedure hospital spells, incurring payer costs of £109 million. The mean PUL procedure cost in 2015/16 was £2,405. Typically, no hospital stay or catheterisation are required. Most adverse events (mainly dysuria, discomfort, urgency, and haematuria) are mild to moderate and resolve in 2–4 weeks without hospital treatment. Erectile and ejaculatory function are preserved. LUTS improvement is comparable to that for TURP but is more rapid and remains stable at 5 years. If we assume, based on this complication profile, that the £109 million spending on complications could be halved and that 50% of TURP recipients would be candidates for PUL, we estimate a saving of £27 million per year. PUL could reduce complications, improve quality of life, and substantially reduce costs currently associated with current standard TURP practice.