Current Urology Reports

, 19:72 | Cite as

Costs of Managing Benign Prostatic Hyperplasia in the Office and Operating Room

  • Bradley C. GillEmail author
  • James C. Ulchaker
Benign Prostatic Hyperplasia (K McVary, Section Editor)
Part of the following topical collections:
  1. Topical Collection on Benign Prostatic Hyperplasia


Purpose of Review

To review the costs associated with benign prostatic hyperplasia (BPH) management. Specifically, to compare the costs of medical therapy, office-based procedures, and surgical management from a payer perspective.

Recent Findings

The American Urological Association released updated guidelines in 2018 for the surgical management of BPH. Over recent years, analyses investigating the cost-effectiveness of the modalities included in these guidelines have been completed. These show relatively newer, minimally-invasive office-based therapies can provide cost-effective alternatives to medical therapy. Likewise, surgical therapies provide a cost-effective means of BPH management, if performed well with low complication rates. However, comparisons of these studies are limited by the biases they contain.


Minimally-invasive office-based therapies and well performed surgical therapies for BPH can achieve cost equivalence to combination medical therapy within a few years. Factors such as age, gland size, patient compliance, and surgeon skill should be considered when personalizing treatment recommendations for each patient.


Benign prostatic hyperplasia Benign prostate hyperplasia Medical therapy Transurethral Minimally invasive Cost 


Compliance with Ethical Standards

Conflict of Interest

Bradley C. Gill and James C. Ulchaker each declare no potential conflicts 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.


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

  1. 1.
    • Malaeb BS, Yu X, McBean AM, Elliott SP. National trends in surgical therapy for benign prostatic hyperplasia in the United States (2000-2008). Urology. 2012;79:1111–6. An analysis of national trends in BPH treatment that showed how the use of various treatments changed over time as newer modalities established themselves and less effective ones lost traction. CrossRefPubMedPubMedCentralGoogle Scholar
  2. 2.
    Kaplan SA, Kohler TS, Lerner LB, Deb J, Parsons JK, Roehrborn CG, et al. Surgical management of lower urinary tract symptoms attributed to benign prostatic hyperplasia: AUA GUIDELINE American Urological Association ( AUA ) benign prostatic hyperplasia. 2018;1–29.Google Scholar
  3. 3.
    Roehrborn CG, Siami P, Barkin J, Damião R, Major-Walker K, Nandy I, et al. The effects of combination therapy with dutasteride and tamsulosin on clinical outcomes in men with symptomatic benign prostatic hyperplasia: 4-year results from the CombAT study. Eur Urol. 2010;57:123–31.CrossRefPubMedGoogle Scholar
  4. 4.
    McConnell JD, Roehrborn CG, Bautista OM, Andriole GL, Dixon CM, Kusek JW, et al. The long-term effect of doxazosin, finasteride, and combination therapy on the clinical progression of benign prostatic hyperplasia. N Engl J Med. 2003;349:2387–98.CrossRefPubMedGoogle Scholar
  5. 5.
    Morlock R, Goodwin B, Gomez Rey G, Eaddy M. Clinical progression, acute urinary retention, prostate-related surgeries, and costs in patients with benign prostatic hyperplasia taking early versus delayed combination 5α-reductase inhibitor therapy and α-blocker therapy: a retrospective analysis. Clin Ther. 2013;35:624–33.CrossRefPubMedGoogle Scholar
  6. 6.
    Messina R, Mirone V. Benign prostatic hyperplasia—an economic assessment of fixed combination therapy based on a literature review. Arch Ital di Urol Androl organo Uff [di] Soc Ital di Ecogr Urol e Nefrol. 2015;87:185–9.CrossRefGoogle Scholar
  7. 7.
    Nickel JC. Comparison of clinical trials with finasteride and dutasteride. Rev Urol. 2004;6(Suppl 9):S31–9.PubMedPubMedCentralGoogle Scholar
  8. 8.
    Thomas JA, Tubaro A, Barber N, Thorpe A, Armstrong N, Bachmann A, et al. The continuing story of the cost-effectiveness of photoselective vaporization of the prostate versus transuretheral resection of the prostate for the treatment of symptomatic benign prostatic obstruction. Value Heal. 2015;18:376–86.CrossRefGoogle Scholar
  9. 9.
    Liatsikos E, Kyriazis I, Kallidonis P, Sakellaropoulos G, Maniadakis N. Photoselective GreenLightTM laser vaporization versus transurethral resection of the prostate in Greece: a comparative cost analysis. J Endourol. 2012;26:168–73.CrossRefPubMedGoogle Scholar
  10. 10.
    Benejam-Gual JM, Sanz-Granda A, García-Miralles Grávalos R, Severa-Ruíz De Velasco A, Pons-Viver J. Análisis coste efectividad a 2 años del tratamiento quirúrgico de la hiperplasia benigna de próstata mediante vaporización fotoselectiva de la próstata con GreenLight- PhotoVaporization 120 W versus resección transuretral de la próstata. Actas Urol Esp. 2014;38:238–43.CrossRefPubMedGoogle Scholar
  11. 11.
    Skinner TAA, Leslie RJ, Steele SS, Nickel JC. Randomized, controlled trial of laser vs. bipolar plasma vaporization treatment of benign prostatic hyperplasia. Can Urol Assoc J. 2017;11:194–8.CrossRefPubMedPubMedCentralGoogle Scholar
  12. 12.
    Rai P, Srivastava A, Dhayal IR, Singh S. Comparison of safety, efficacy and cost effectiveness of photoselective vaporization with bipolar vaporization of prostate in benign prostatic hyperplasia. Curr Urol. 2017;11:103–9.CrossRefPubMedPubMedCentralGoogle Scholar
  13. 13.
    Hsu YC, Lin YH, Chou CY, Hou CP, Chen CL, Chang PL, et al. Economic evaluation study (cheer compliant) laser prostatectomy for benign prostatic hyperplasia: Outcomes and cost-effectiveness. Med (United States). 2016;95:1–5.Google Scholar
  14. 14.
    Whitty JA, Crosland P, Hewson K, Narula R, Nathan TR, Campbell PA, et al. A cost-minimisation analysis comparing photoselective vaporisation (PVP) and transurethral resection of the prostate (TURP) for the management of symptomatic benign prostatic hyperplasia (BPH) in Queensland. Australia BJU Int. 2014;113:21–8.CrossRefPubMedGoogle Scholar
  15. 15.
    Yu X, Elliott SP, Wilt TJ, McBean AM. Practice patterns in benign prostatic hyperplasia surgical therapy: the dramatic increase in minimally invasive technologies. J Urol. 2008;180:241–5.CrossRefPubMedGoogle Scholar
  16. 16.
    •• Roehrborn CG, Barkin J, Gange SN, Shore ND, Giddens JL, Bolton DM, et al. Five year results of the prospective randomized controlled prostatic urethral L.I.F.T. study. Can J Urol. 2017;24:8802–13. The most current data on the prostatic urethral lift for BPH treatment. Overall, efficacy of the treatment appears to extend through 5 years of follow-up. PubMedGoogle Scholar
  17. 17.
    •• McVary KT, Roehrborn CG. Three-Year Outcomes of the Prospective, Randomized Controlled Rezūm System Study: Convective Radiofrequency Thermal Therapy for Treatment of Lower Urinary Tract Symptoms Due to Benign Prostatic Hyperplasia. Urology. 2018;111:1–9. The most current data on water vapor ablation for BPH treatment. Overall, efficacy of the treatment appears to extend through 3 years of follow-up. CrossRefPubMedGoogle Scholar
  18. 18.
    •• Ulchaker JC, Martinson M. Cost-effectiveness analysis of six therapies for the treatment of lower urinary tract symptoms due to benign prostatic hyperplasia. Clin Outcomes Res. 2017;10:29–43. An in-depth and thorough analysis of the most contemporary BPH treatments. Cost-effectiveness was determined for each therapy with regard to its effect on symptom scores. Relative comparisons between treatments were also provided. This is likely the most in-depth economic analysis of current BPH treatments CrossRefGoogle Scholar
  19. 19.
    Kaplan AL, Agarwal N, Setlur NP, Tan HJ, Niedzwiecki D, McLaughlin N, et al. Measuring the cost of care in benign prostatic hyperplasia using time-driven activity-based costing (TDABC). Healthcare. 2015;3:43–8.CrossRefPubMedGoogle Scholar
  20. 20.
    Zhong C, Wen W, Xia S. Cost and effectiveness analysis of treatments for benign prostatic hyperplasia. Zhonghua Yi Xue Za Zhi. 2016;96:289–92.PubMedGoogle Scholar
  21. 21.
    Ray A, Morgan H, Wilkes A, Carter K, Carolan-Rees G. The Urolift system for the treatment of lower urinary tract symptoms secondary to benign prostatic hyperplasia: a NICE medical technology guidance. Appl Health Econ Health Policy. 2016;14:515–26.CrossRefPubMedPubMedCentralGoogle Scholar
  22. 22.
    Smith C, Craig P, Taleb S, Young S, Golzarian J. Comparison of traditional and emerging surgical therapies for lower urinary tract symptoms in men: a review. Cardiovasc Intervent Radiol. 2017;40:1176–84.CrossRefPubMedGoogle Scholar
  23. 23.
    Stovsky MD, Rhee K, Hartke D. Medical therapy versus surgery and minimally invasive surgical therapies for lower urinary tract symptoms and benign prostatic hyperplasia: what makes better economic sense? Curr Urol Rep. 2007;8:289–97.CrossRefPubMedGoogle Scholar
  24. 24.
    Taub DA, Wei JT. The economics of benign prostatic hyperplasia and lower urinary tract symptoms in the United States. Curr Urol Rep 2006.Google Scholar
  25. 25.
    • Stovsky MD, Griffiths RI, Duff SB. A clinical outcomes and cost analysis comparing Photoselective vaporization of the prostate to alternative minimally invasive therapies and transurethral prostate resection for the treatment of benign prostatic hyperplasia. J Urol. 2006;176:1500–6. An early Markov model of various BPH treatments that demonstrated how newer laser and microwave therapies matched up against transurethral resection of the prostate. CrossRefPubMedGoogle Scholar
  26. 26.
    Disantostefano RL, Biddle AK, Lavelle JP. An evaluation of the economic costs and patient-related consequences of treatments for benign prostatic hyperplasia (structured abstract). BJU Int. 2006;97:1007–16.CrossRefPubMedGoogle Scholar
  27. 27.
    Lerner LB, Thurmond P, Harsch MR, Martinson MS. Office-based HE-TUMT costs less than medication over four years in treating benign prostatic hyperplasia. Surg Technol Int. 2015;26:182–9.PubMedGoogle Scholar
  28. 28.
    • Bellinger AS, Elliott SP, Yang L, Wei JT, Saigal CS, Smith A, et al. Changes in initial expenditures for benign prostatic hyperplasia evaluation in the medicare population: a comparison to overall Medicare inflation. J Urol [Internet]. Elsevier Inc.; 2012;187:1739–46. Available from: A study of national trends in the diagnosis and evaluation of BPH from a Medicare perspective. In line with current guidelines, this study found an increase in the use of imaging during BPH evaluations.
  29. 29.
    Mathieu R, Lebdai S, Cornu JN, Benchikh A, Azzouzi AR, Delongchamps NB, et al. Analyse du coût et des résultats périopératoires des traitements chirurgicaux de l’hypertrophie bénigne de prostate: une étude du Comité des troubles mictionnels de l’homme de l’association française d’urologie. Prog Urol. 2017;27:362–8.CrossRefPubMedGoogle Scholar
  30. 30.
    Kirby RS, Kirby M, Fitzpatrick JM. Benign prostatic hyperplasia: counting the cost of its management. BJU Int 2010.Google Scholar
  31. 31.
    Vuichoud C, Loughlin KR. Benign prostatic hyperplasia: epidemiology, economics and evaluation. Can J Urol. 2015;22:1–6.PubMedGoogle Scholar

Copyright information

© Springer Science+Business Media, LLC, part of Springer Nature 2018

Authors and Affiliations

  1. 1.Department of UrologyGlickman Urological and Kidney Institute, Cleveland ClinicClevelandUSA
  2. 2.Lerner College of MedicineEducation Institute, Cleveland ClinicClevelandUSA
  3. 3.Department of Biomedical EngineeringLerner Research Institute, Cleveland ClinicClevelandUSA

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