Review of the Economics of Surgical Treatment Options for Benign Prostatic Hyperplasia.

Abstract

The goal of this paper is to review the literature detailing US-based analyses for cost and cost-effectiveness of surgical treatment options for benign prostatic hypertrophy (BPH) and associated LUTS. TURP offers the greatest degree of symptom improvement with its associated costs dependent upon operating room time, equipment, and length of hospital stay. Other studied surgical treatment modalities, including transurethral laser ablative, thermal ablative, and convective water vapor modalities as well as prostatic urethral lift and transabdominal procedures, generally carry higher costs and lower cost-effectiveness in both inpatient and outpatient settings, with specific exceptions. Compared to TURP, HoLEP and Greenlight PVP have demonstrated superior cost-effectiveness for mild, moderate, and severe BPH. Convective water vapor ablation, as with transurethral microwave/thermoablative therapies, has been observed to be less expensive per procedure than TURP on average. However, it conferred lower degrees of IPSS symptom improvement. Moreover, compared to TURP, prostatic artery embolization has demonstrated lower average costs coupled with inferior objective improvement in maximal flow rate, prostate volume reduction, PSA decline and minimal improvement in IPSS subjective outcome measures. For this review, selection bias, asymmetric patient groups, issues with study aggregation, and understudied cost contributors (including retreatment costs, long-term durability of symptom relief, recovery time, and work productivity limitations) were identified as key limitations. Nevertheless, this overview takes important steps to understand the costs of surgical treatment options for BPH, allowing for more informed clinical and policy decisions.