The Oxford Laser Prostate Trial: economic issues surrounding contact laser prostatectomy

To compare the economic implications of transurethral resection of the prostate (TURP) and contact-laser vaporization of the prostate (with the SLT system) using data obtained from a randomized controlled trial.

All aspects of management before, during and after surgery on 102 patients, followed up for 3 months, were costed and analysed. Based on the data from the trial, the mean costs were calculated. A sensitivity analysis was then performed to examine the effect of changes in some of the relevant variables. The mean difference in cost between laser treatment and TURP was plotted against the cost of laser consumables, assuming a 5% re-operation rate for both operations at 5 years and a 5% discount rate. A range of laser re-operation rates was compared with the mean difference in costs, assuming a hospital stay of one night and two district-nurse visits. Other assumptions on discounts and re-operation rates, based on collected data, were also tested.

TURP will remain more economical until the cost of laser consumables is reduced to 20% of the current list price, or a hospital stay of one night is introduced.

The costs of contact-laser vaporization of the prostate are likely to exceed the costs of TURP unless laser treatment is accompanied by a more active approach to post-operative management, including a hospital stay of one night and, if necessary, the removal of the patient's catheter at home by a district nurse.