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Cost-effectiveness of Medical Versus Surgical Therapy for BPH

  • Valentin Shabataev
  • Ashraf Allahwala
  • Dean S. EltermanEmail author
BPH-Related Voiding Dysfunction (R Lee, Section Editor)
  • 7 Downloads
Part of the following topical collections:
  1. Topical Collection on BPH-Related Voiding Dysfunction
  2. Topical Collection on BPH-Related Voiding Dysfunction

Abstract

Purpose of Review

Benign prostatic enlargement and obstruction may result in lower urinary tract symptom (LUTS) and have a negative impact on a patient’s quality of life. The purpose of this review is to analyze different management options, specifically evaluating the cost-effectiveness of medical versus surgical therapy for BPH.

Recent Findings

We performed a detailed review comparing various studies regarding the cost-effectiveness of different management options that were conducted in the last 5 years. When comparing monotherapy with combination therapy in medical treatments, the latter was found to be more cost-effective. Branded combined medical therapies were found to be much more expensive than generic medical therapies but demonstrated the same therapeutic outcome. When looking at operative options, specifically among the transurethral surgeries, there are more invasive options, including mono/bipolar transurethral resection of prostate (TURP) and laser vaporization and there are less invasive modalities (MIST) such as Urolift, Rezūm, transurethral microwave thermotherapy (TUMT), and transurethral needle ablation (TUNA). The findings demonstrated the cost of the more invasive options depended on whether the procedure was conducted as an inpatient or outpatient, with inpatient surgeries being the more expensive. In this context, GreenLight PVP, being performed as an outpatient procedure, was less expensive than TURP. Both of them provided the best relief in BPH symptoms but were found to have a higher incidence of side effects. Accordingly, it has been estimated the cost of MIST to be not only cheaper (except Urolift) than invasive transurethral options, but noted to have fewer side effects, especially in terms of ejaculatory dysfunction.

Summary

Although combination generic medical therapy has been shown to be the least costly option, when invasive surgical management, such as TURP or GreenLight PVP as the most expensive, cost by itself is not the only metric to assess a BPH therapy. The more valuable criterion, such as cost-effectiveness, must be examined. In this light, MIST and especially Rezūm do appear to have a cost-effectiveness advantage over the other procedures due to its lower price and fewer side effects, while providing similar clinical efficacy.

Keywords

Benign prostatic hyperplasia Benign prostatic enlargement BPH Cost-effectiveness Cost utility Comparison BPH treatments 

Notes

Compliance with Ethical Standards

Conflict of Interest

Dr. Dean Elterman declares consultancy and scientific advisory board with Boston Scientific. Dr. Valentin Shabataev and Dr. Ashraf Allahwala declare that they have no conflict of interest.

Human and Animal Rights and Informed Consent

This article does not contain any studies with human or animal subjects performed by any of the authors.

References

Papers of particular interest, published recently, have been highlighted as: • Of importance •• Of major importance

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Copyright information

© Springer Science+Business Media, LLC, part of Springer Nature 2019

Authors and Affiliations

  • Valentin Shabataev
    • 1
  • Ashraf Allahwala
    • 1
  • Dean S. Elterman
    • 1
    • 2
    Email author
  1. 1.Division of Urology, Department of SurgeryUniversity of TorontoTorontoCanada
  2. 2.Toronto Western HospitalTorontoCanada

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