In‐hospital cost analysis of prostatic artery embolization compared with transurethral resection of the prostate: post hoc analysis of a randomized controlled trial

Abstract

ObjectivesTo perform a post hoc analysis of in‐hospital costs incurred in a randomized controlled trial comparing prostatic artery embolization (PAE) and transurethral resection of the prostate (TURP).Patients and MethodsIn‐hospital costs arising from PAE and TURP were calculated using detailed expenditure reports provided by the hospital accounts department. Total costs, including those arising from surgical and interventional procedures, consumables, personnel and accommodation, were analysed for all of the study participants and compared between PAE and TURP using descriptive analysis and two‐sided t‐tests, adjusted for unequal variance within groups (Welch t‐test).ResultsThe mean total costs per patient (±sd) were higher for TURP, at €9137 ± 3301, than for PAE, at €8185 ± 1630. The mean difference of €952 was not statistically significant (P = 0.07). While the mean procedural costs were significantly higher for PAE (mean difference €623 [P = 0.009]), costs apart from the procedure were significantly lower for PAE, with a mean difference of €1627 (P < 0.001). Procedural costs of €1433 ± 552 for TURP were mainly incurred by anaesthesia, whereas €2590 ± 628 for medical supplies were the main cost factor for PAE.ConclusionsSince in‐hospital costs are similar but PAE and TURP have different efficacy and safety profiles, the patient's clinical condition and expectations – rather than finances – should be taken into account when deciding between PAE and TURP.

Significance of the pharmacoeconomic approach in the choice of treatment of hyperplasia of the prostate

“…Urologicheskie vedomosti. 2019;9(4): [59][60][61][62][63][64][65][66][67][68][69][70][71][72]. https://doi.org/10.17816/uroved9459-72 ВВЕДЕНИЕ Увеличение продолжительности жизни населения приводит к возрастанию доли лиц пожилого и старческого возраста [1].…”

Prostatic artery embolization: adding to the arsenal against the hapless prostate

“…In this issue of BJUI , Müllhaupt et al. report an in‐hospital cost analysis of PAE compared to TURP, in their post hoc analysis of a randomized controlled trial. Treatment costs are an important component of healthcare but are a narrow and focused view of the overall management of BPH in an individual patient.…”

“…. It should be noted that PAE can be a technically challenging procedure and, although bilateral embolization is the goal, only unilateral embolization is possible in 25% of cases . Highly specialized training is required, and the technique continues to evolve to avoid embolization of extraprostatic branches .…”

“…Highly specialized training is required, and the technique continues to evolve to avoid embolization of extraprostatic branches . PAE is more painful than TURP, with higher reported pain on a visual analogue scale and higher analgesic use , but is associated with a shorter length of hospital stay . PAE is reported to be associated with an earlier return to normal activities but is less effective than TURP at 12 weeks with regard to changes in maximum rate of urinary flow, postvoid residual urine, prostate volume and desobstructive effectiveness according to pressure flow studies and has a 20% re‐operation rate after 12 months .…”

“…Müllhaupt et al. showed that PAE was associated with a quicker return to normal activities and a shorter length of stay than TURP, with similar in‐hospital costs in Switzerland. Cost, however, must be considered alongside safety and efficacy data both in the short and long term.…”