Costs of Managing Benign Prostatic Hyperplasia in the Office and Operating Room

Gill, Bradley C.; Ulchaker, James

doi:10.1007/s11934-018-0822-z

Cited by 22 publications

(11 citation statements)

References 29 publications

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“…The advantages of the Rezum water vapor thermal therapy compare favorably with other options, and can achieve cost equivalence to combination medical therapy within a few years. 24,25 Relative to reimbursement for this procedure, the AMA/CPT Coding Committee announced that Rezum meets all the stringent requirements for a unique Category I CPT Code. CPT 53854 became effective in January 2019.…”

Section: Resultsmentioning

confidence: 99%

Rezūm Water Vapor Thermal Therapy for Lower Urinary Tract Symptoms Associated With Benign Prostatic Hyperplasia: 4-Year Results From Randomized Controlled Study

McVary

Rogers

Roehrborn

2019

Urology

175

140

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OBJECTIVETo report 4-year outcomes of the randomized controlled trial of water vapor thermal therapy for treatment of moderate to severe lower urinary tract symptoms due to benign prostatic hyperplasia. MATERIALS AND METHODSTotal 188 subjects; 135 men ≥50 years old, International Prostate Symptom Score ≥ 13, maximum flow rate (Qmax) ≤15 mL/s and prostate volume 30 to 80 cc treated with Rezum System thermal therapy were followed 4 years; subset of 53 men who requalified for crossover from control to active treatment were followed 3 years. RESULTSLower urinary tract symptoms were significantly improved within ≤3 months after thermal therapy and remained consistently durable (International Prostate Symptom Score 47%, quality of life 43%, Qmax 50%, Benign Prostatic Hyperplasia Impact Index 52%) throughout 4 years (P <.0001); outcomes were similarly sustained in crossover subjects at 3 years. Surgical retreatment rate was 4.4% over 4 years. No disturbances in sexual function were reported. CONCLUSION The minimally invasive thermal therapy provides effective symptom relief and improved quality of life that remains durable for over 4 years. It is applicable to all prostate zones with procedures performed under local anesthesia in an office setting. UROLOGY 126: 171−179, 2019. B y the seventh decade of life approximately 70% of men have histological evidence of histological stromoglandular hyperplasia, namely benign prostatic hyperplasia (BPH). This hyperplasia is commonly associated with progressive development of voiding and storage related lower urinary tract symptoms (LUTS). Several options exist for BPH management with a significant range of invasiveness, efficacy, and cost. The therapy a patient pursues should rely on careful physical evaluation and informed discussion with his provider. Decision making varies according to severity of symptoms, gland size, anatomical features, and efficacy and safety of the different treatments. Minimally invasive surgical treatments (MISTs), both thermal and mechanical expander options, represent alternative intervention before or after any pharmacotherapy.The newest MIST is water vapor thermal therapy using radiofrequency to create thermal energy (Rezum System, Boston Scientific, Marlborough, MA) in the form of water vapor. This therapy was specifically developed as a platform technology for transurethral energy transfer using the convective properties of water, releasing large amounts of stored thermal energy (540 calories/mL H 2 O) as the vapor contacts prostate tissue and condenses back to water.

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Section: Resultsmentioning

confidence: 99%

Rezūm Water Vapor Thermal Therapy for Lower Urinary Tract Symptoms Associated With Benign Prostatic Hyperplasia: 4-Year Results From Randomized Controlled Study

McVary

Rogers

Roehrborn

2019

Urology

175

140

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“…Based on our findings, indications exist that performing laryngopharyngeal surgery in the office under topical anesthesia instead of the OR under GA results in significant costs savings for the hospital and third party payer. Other fields of medicine have also shown cost reductions in shifting surgical interventions to the office [31-34]. To gain full understanding of costs involved in these procedures, broad multi-center cost-effectiveness studies are necessary.…”

Section: Discussionmentioning

confidence: 99%

Office-based vs. operating room-performed laryngopharyngeal surgery: a review of cost differences

Schimberg

Wellenstein

Broek

et al. 2019

Eur Arch Otorhinolaryngol

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PurposeOffice-based transnasal flexible endoscopic surgery under topical anesthesia has recently been developed as an alternative for transoral laryngopharyngeal surgery under general anesthesia. The aim of this study was to evaluate differences in health care costs between the two surgical settings.MethodsPubMed, EMBASE and Cochrane Library were searched for studies reporting on costs of laryngopharyngeal procedures that could either be performed in the office or operating room (i.e., laser surgery, biopsies, vocal fold injection, or hypopharyngeal or esophageal dilation). Quality assessment of the included references was performed.ResultsOf 2953 identified studies, 13 were included. Quality assessment revealed that methodology differed significantly among the included studies. All studies reported lower costs for procedures performed in the office compared to those performed in the operating room. The variation within reported hospital and physician charges was substantial.ConclusionOffice-based laryngopharyngeal procedures under topical anesthesia result in lower costs compared to similar procedures performed under general anesthesia.Electronic supplementary materialThe online version of this article (10.1007/s00405-019-05617-z) contains supplementary material, which is available to authorized users.

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“…The company did not submit any new economic evidence for this review. However, the EAC identified one published cost-effectiveness model [ 19 ], one cost equivalence [ 20 ] and one related review [ 21 ] that included cost information from the main literature search for the topic. All were set in the USA, and so were not of direct relevance to inform the current guidance review.…”

Section: Cedar’s Review Of the Evidencementioning

confidence: 99%

UroLift for Treating Lower Urinary Tract Symptoms of Benign Prostatic Hyperplasia: A NICE Medical Technology Guidance Update

Knight

Dale

Cleves

et al. 2022

Appl Health Econ Health Policy

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Lower urinary tract symptoms (LUTS) commonly occur as a consequence of benign prostatic hyperplasia (BPH), also known as prostate enlargement. Treatments for this can involve electrosurgical removal of a section of the prostate via transurethral resection of the prostate (TURP), Holmium laser enucleation of the prostate (HoLEP), or prostatic urethral lift using the UroLift system. The UroLift system implants to pull excess prostatic tissue away so that it does not narrow or block the urethra. In this way, the device is designed to relieve symptoms of urinary outflow obstruction without cutting or removing tissue. National guidance recommending the use of UroLift in the UK NHS was first issued in 2015 by the National Institute for Health and Care Excellence (NICE MTG26). We now report on the process to update the economic evaluation of UroLift, leading to updated NICE guidance published in May 2021 (NICE MTG58). The conclusions of the available clinical evidence were mixed and suggested that whilst UroLift improves symptoms over time, this improvement is smaller than that of TURP for symptom severity (IPSS) and urological outcomes. However, UroLift appears to be superior to Rezum for symptom severity and measures of erectile dysfunction and ejaculatory dysfunction. The updated economic model estimated that using UroLift as a day-case procedure for people with prostate of volume 30-80 mL creates a saving of £981 per person compared with bipolar TURP, £1242 compared with monopolar TURP, and £1230 compared with HoLEP.

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Costs of Managing Benign Prostatic Hyperplasia in the Office and Operating Room

Cited by 22 publications

References 29 publications

Rezūm Water Vapor Thermal Therapy for Lower Urinary Tract Symptoms Associated With Benign Prostatic Hyperplasia: 4-Year Results From Randomized Controlled Study

Rezūm Water Vapor Thermal Therapy for Lower Urinary Tract Symptoms Associated With Benign Prostatic Hyperplasia: 4-Year Results From Randomized Controlled Study

Office-based vs. operating room-performed laryngopharyngeal surgery: a review of cost differences

UroLift for Treating Lower Urinary Tract Symptoms of Benign Prostatic Hyperplasia: A NICE Medical Technology Guidance Update

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