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Related Experiment Video

Updated: Jul 8, 2025

Surgical Treatment for Benign Prostatic Hyperplasia: Holmium Laser Enucleation of the Prostate HoLEP.
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Comparison of Minimally Invasive Procedures for Benign Prostatic Hyperplasia: A Cost-effectiveness Analysis.

Xiao Wu1, Alice Zhou1, Michael Heller1

  • 1From the Department of Radiology and Biomedical Imaging (X.W., A.Z., M.H., R.K.) and Department of Urology (T.C.), University of California-San Francisco, 505 Parnassus Ave, San Francisco, CA 94143.

Radiology
|December 12, 2023
PubMed
Summary

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Prostatic artery embolization (PAE) is a cost-effective treatment for benign prostatic hyperplasia (BPH), offering comparable outcomes to other minimally invasive therapies (MITs) at a lower expected cost. This analysis compared PAE with medical management and other MITs over five years.

Area of Science:

  • Urology
  • Health Economics
  • Medical Technology Assessment

Background:

  • Benign prostatic hyperplasia (BPH) affects millions of men in the U.S., presenting significant treatment costs.
  • Evaluating cost-effectiveness is crucial for optimizing BPH management strategies.

Purpose of the Study:

  • To conduct a comparative cost-effectiveness analysis of four minimally invasive therapies (MITs) and medical management for BPH.
  • To determine the most economically viable treatment option from a payer's perspective.

Main Methods:

  • A 5-year Markov model was employed for cost-effectiveness analysis, incorporating procedural complications and retreatment probabilities from published data.
  • Costs were derived from Medicare reimbursements, and outcomes were measured using quality-adjusted life years (QALYs).

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  • Statistical analyses included base case, probabilistic, and deterministic sensitivity analyses.

    • Main Results:

    • Prostatic artery embolization (PAE) demonstrated the highest effectiveness (0.030 QALY difference) and was the most cost-effective strategy compared to medical management ($64,842 per QALY).
    • PAE was found to be more cost-effective than prostatic urethral lift, aquablation, and water vapor therapy in pairwise comparisons.
    • PAE remained optimal unless retreatment rates exceeded 2.30% per 6 months, or its procedural cost surpassed $4755.

    Conclusions:

    • Prostatic artery embolization (PAE) emerges as a cost-effective modality for BPH treatment compared to medical management and other MITs.
    • PAE offers comparable outcomes to prostatic urethral lift, water vapor therapy, and aquablation, but at a lower expected cost.
    • The study highlights PAE's potential as a preferred option, contingent on procedural costs and retreatment rates.