Hospital-based direct cost comparison between open simple prostatectomy and HoLEP

To compare hospital-based direct costs of care for patients with benign prostatic hyperplasia undergoing open simple prostatectomy (OSP) versus holmium laser enucleation of the prostate (HoLEP).

A retrospective hospital-based direct cost analysis was performed through review of medical records and institutional billing data for patients surgically treated for BPH with OSP versus HoLEP. Direct costs included personnel, facilities, equipment, consumables, and medications. Costs were retrieved from the institutional billing system and converted to U.S. dollars using the official exchange rate at the time of billing.

Fifty patients were included (25 per group). Age and prostate volume were comparable between groups. Patients undergoing open simple prostatectomy (OSP) had a longer length of stay and more frequent postoperative ICU admission, resulting in higher total direct hospital costs compared with HoLEP (USD 4,676 vs. USD 3,360; p < 0.001). Although initial procedural costs were higher for HoLEP, this did not result in higher total costs.

Despite higher procedural costs, HoLEP was associated with lower short-term hospital-based direct costs than OSP. Reduced postoperative resource utilization was the principal determinant of the lower total hospital costs observed with HoLEP. These findings provide context-specific economic evidence to support institutional decision-making in similar healthcare settings.