Abstract
Objective
To compare the cost-effectiveness of surgical interventions for BPH.
Methods
Using a Markov model, a cost-utility analysis was performed comparing HoLEP, B-TURP,
WVTT, and PUL for prostate size <80cc (index patient 1) and HoLEP and SP for prostate
size >80cc (index patient 2). Model probabilities and utility values were drawn from
the literature. Analysis was performed at a 5-year time horizon with extrapolation
to a lifetime horizon. Primary outcomes included quality-adjusted life years (QALYs),
2021 Medicare costs, and incremental cost-effectiveness ratios (ICERs) with a willingness-to-pay
threshold of $100,000/QALY. Univariate and probabilistic sensitivity analyses were
performed.
Results
At 5 years, costs per patient for index patient 1 were $3292 (WVTT), $6532 (HoLEP),
$6670 (B-TURP), and $10,257 (PUL). HoLEP resulted in the highest QALYs (4.66), followed
by B-TURP (4.60), PUL (4.38), and WVTT (4.38). This translated to HoLEP being most
cost-effective (ICER $11,847). For index patient 2, HoLEP was less costly ($6,585
vs $15,404) and more effective (4.654 vs 4.650) relative to SP. On sensitivity analysis
for index patient 1, B-TURP became most cost-effective if cost of HoLEP increased
two-fold or chronic stress incontinence following HoLEP increased ten-fold. When follow-up
time was varied, WVTT was preferred at very short follow up (<1 year), and HoLEP became
more strongly preferred with longer follow up.
Conclusion
At 5 years follow up, HoLEP is a cost-effective surgical treatment for BPH- independent
of gland size.
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Article info
Publication history
Published online: October 18, 2022
Accepted:
September 20,
2022
Received:
July 1,
2022
Footnotes
Financial Disclosure: The authors declare that they have no relevant financial interests.
Funding Support: This work was supported in part by the Mayo Clinic Robert D. and Patricia E. Kern Center for the Science of Health Care Delivery.
Identification
Copyright
© 2022 Published by Elsevier Inc.
