Cost-Effectiveness of Contemporary Surgical Treatment Options for Benign Prostatic Hyperplasia

To compare the cost-effectiveness of all guideline-supported surgical management options for BPH, stratified by prostate size.

Using a microsimulation model, a cost-effectiveness analysis was performed comparing all guideline-supported surgical management options for BPH, stratified by prostate size. Model probabilities were based on published values and effectiveness was calculated using post-operative outcomes. Costs were from a U.S. Medicare payer perspective, with quality-adjusted life years (QALYs) and incremental cost-effectiveness ratios (ICERs) used to assess cost-effectiveness.

At a lifetime horizon for patients with 30-80cc prostate size, HoLEP resulted in the highest QALYs (12.25), followed by iTIND (12.02) and WVTT (11.98). BPH costs per patient ranged from $6,557 (WVTT) and $8,431 (HoLEP) to $16,230 (PAE), with a low ICER for HoLEP ($6,931/QALY). For large glands (80-150cc), HoLEP resulted in nearly identical effectiveness relative to SP (12.25 vs. 12.26 QALYs) and more than RWT (12.19 QALYs). HoLEP had a significantly lower cost ($8,361) than SP ($19,012), RWT ($11,969), and PAE ($16,230) and was therefore cost-effective. However, for both index patients, cost-effectiveness was dependent on the value placed on post-operative ejaculatory dysfunction and post-surgery urinary symptom improvement.

At base-case with population-level assumptions, HoLEP is the most cost-effective BPH surgical option for patients with average or large prostate size. However, this is highly dependent upon patient priorities, highlighting the importance of surgical selection driven by individual patient preferences.