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Keywords:

  • benign prostatic hyperplasia;
  • transurethral resection of the prostate;
  • photoselective vaporisation of the prostate;
  • cost-minimisation analysis;
  • Australia

Objectives

  • To compare the costs of photoselective vaporisation (PVP) and transurethral resection of the prostate (TURP) for management of symptomatic benign prostatic hyperplasia (BPH) from the perspective of a Queensland public hospital provider.

Patients and Methods

  • A decision-analytic model was used to compare the costs of PVP and TURP.
  • Cost inputs were sourced from an audit of patients undergoing PVP or TURP across three hospitals.
  • The probability of re-intervention was obtained from secondary literature sources.
  • Probabilistic and multi-way sensitivity analyses were used to account for uncertainty and test the impact of varying key assumptions.

Results

  • In the base case analysis, which included equipment, training and re-intervention costs, PVP was AU$ 739 (95% credible interval [CrI] –12 187 to 14 516) more costly per patient than TURP.
  • The estimate was most sensitive to changes in procedural costs, fibre costs and the probability of re-intervention.
  • Sensitivity analyses based on data from the most favourable site or excluding equipment and training costs reduced the point estimate to favour PVP (incremental cost AU$ –684, 95% CrI –8319 to 5796 and AU$ –100, 95% CrI –13 026 to 13 678, respectively). However, CrIs were wide for all analyses.

Conclusions

  • In this cost minimisation analysis, there was no significant cost difference between PVP and TURP, after accounting for equipment, training and re-intervention costs.
  • However, PVP was associated with a shorter length of stay and lower procedural costs during audit, indicating PVP potentially provides comparatively good value for money once the technology is established.