Cost-Effectiveness and Budget Impact of Emerging Minimally Invasive Surgical Treatments for Benign Prostatic Hyperplasia

Abstract

Background: Benign prostatic hyperplasia (BPH) is one of the most prevalent and costly chronic conditions among middle-aged and elderly men. Prostatic urethral lift (PUL) and convective water vapor thermal therapy (WVTT) are emerging minimally invasive surgical treatments as an alternative to traditional treatment options for men with moderate-to-severe BPH. This study evaluated the cost-effectiveness and budget impact of PUL and WVTT for men with BPH using long-term clinical outcomes. Methods: The cost-effectiveness and budget impact models were developed from a US Medicare perspective over a 4-year time horizon. The models were populated with males with a mean age of 63 and an average International Prostate Symptom Score (IPSS) of 22. Clinical inputs were extracted from the LIFT and Rezum II randomized controlled trials at 4 years. Utility values were assigned using IPSS and BPH severity levels. Procedural, adverse event, retreatment, follow-up, and medication costs were based on 2019 Medicare payment rates and Medicare Part D drug spending. One-way and probabilistic sensitivity analyses (PSAs) were performed. Results: At 4 years, PUL was associated with greater retreatment rates (24.6% vs 10.9%), lower quality-adjusted life-years (QALYs) (3.490 vs 3.548) and higher total costs (US$7393 vs US$2233) compared with WVTT, making WVTT the more effective and less costly treatment strategy. The 70% total cost difference of PUL and WVTT was predominantly driven by higher PUL procedural (US$5617 vs US$1689) and retreatment (US$976 vs US$257) costs. The PSA demonstrated that relative to PUL, WVTT yielded higher QALYs and lower costs 99% and 100% of the time, respectively. Conclusions: Compared to PUL, WVTT was a cost-effective and cost-saving treatment of moderate-to-severe BPH. These findings provide evidence for clinicians, payers, and health policy makers to help further define the role of minimally invasive surgical treatments for BPH.

Emerging outcomes of water vapor thermal therapy (Rezum) in a broad range of patients with lower urinary tract symptoms secondary to benign prostatic hyperplasia: A systematic review

“…One economic analysis compared cost-effectiveness between six BPH treatments (combination prescription drug therapy, Rezum, conductive radiofrequency thermal therapy [Prostiva], UroLift, Greenlight PVP, and TURP 49 ), while the other compared cost-effectiveness between Rezum and UroLift. 50 Both analyses found Rezum to be more cost-effective when compared to UroLift, 49,50 and the analysis comparing Rezum to the five other BPH treatment options concluded Rezum to be the most cost-and clinically effective treatment for BPH. 49 Therefore, Rezum warrants consideration to be offered as a first-line treatment, alternative to prescription drug therapy, in men seeking relief in LUTS secondary to BPH.…”

“…Recently, two Markov model cost‐effectiveness analyses on BPH treatments were conducted to determine the best use of health care funds and clinical benefits for patients with BPH. One economic analysis compared cost‐effectiveness between six BPH treatments (combination prescription drug therapy, Rezum, conductive radiofrequency thermal therapy [Prostiva], UroLift, Greenlight PVP, and TURP 49 ), while the other compared cost‐effectiveness between Rezum and UroLift 50 . Both analyses found Rezum to be more cost‐effective when compared to UroLift, 49,50 and the analysis comparing Rezum to the five other BPH treatment options concluded Rezum to be the most cost‐ and clinically effective treatment for BPH 49 .…”

What is the role of minimally invasive surgical treatments for benign prostatic enlargement?

“…These procedures may have lower costs related to anaesthesia and inpatient care, but data are insufficient to suggest if they are more cost effective than TURP 1516…”

“…As part of the Cochrane Urology group, we published a network meta-analysis in 2021 on effectiveness of minimally invasive treatments compared with TURP in men with BPE. This included trials in Cochrane reviews on these individual treatments over the past two years 11121516. For this article, we have drawn largely from the network meta-analysis.…”

Recent Updates in Surgical Treatment of Benign Prostatic Hyperplasia: A Review Article

“…As an outpatient or officebased setting without general anaesthesia, it offers lasting relief from LUTS.38 For moderate-to-severe LUTS associated with BPH, Mcvary KT et al concluded in their study that WVTT was the treatment approach of choice when compared to PUL in terms of cost and effectiveness, due to its lesser technical and retreatment expenses. 39 Transurethral Needle Ablation (TUNA): Transurethral needle ablation (TUNA) is a minimally invasive procedure for the treatment of symptomatic benign prostatic hyperplasia (BPH). 40 It employs subordinate radiofrequency energy to trigger discerning necrosis of the hyperplastic prostatic tissue while conserving the urethra and neighbouring structures.…”