Evaluation of the Cost-Effectiveness of Surgical Treatment Options for Benign Prostatic Hyperplasia

Kevin M. Wymer, Gopal Narang, Austen Slade, Vidit Sharma, Viengneesee Thao, Bijan J. Borah, Marcelino Rivera, Scott Cheney, Mitchell R. Humphreys

Research output: Contribution to journalArticlepeer-review


Objective: To compare the cost-effectiveness of surgical interventions for BPH. Methods: Using a Markov model, a cost-utility analysis was performed comparing HoLEP, B-TURP, WVTT, and PUL for prostate size <80cc (index patient 1) and HoLEP and SP for prostate size >80cc (index patient 2). Model probabilities and utility values were drawn from the literature. Analysis was performed at a 5-year time horizon with extrapolation to a lifetime horizon. Primary outcomes included quality-adjusted life years (QALYs), 2021 Medicare costs, and incremental cost-effectiveness ratios (ICERs) with a willingness-to-pay threshold of $100,000/QALY. Univariate and probabilistic sensitivity analyses were performed. Results: At 5 years, costs per patient for index patient 1 were $3292 (WVTT), $6532 (HoLEP), $6670 (B-TURP), and $10,257 (PUL). HoLEP resulted in the highest QALYs (4.66), followed by B-TURP (4.60), PUL (4.38), and WVTT (4.38). This translated to HoLEP being most cost-effective (ICER $11,847). For index patient 2, HoLEP was less costly ($6,585 vs $15,404) and more effective (4.654 vs 4.650) relative to SP. On sensitivity analysis for index patient 1, B-TURP became most cost-effective if cost of HoLEP increased two-fold or chronic stress incontinence following HoLEP increased ten-fold. When follow-up time was varied, WVTT was preferred at very short follow up (<1 year), and HoLEP became more strongly preferred with longer follow up. Conclusion: At 5 years follow up, HoLEP is a cost-effective surgical treatment for BPH- independent of gland size.

Original languageEnglish (US)
Pages (from-to)96-102
Number of pages7
StatePublished - Jan 2023

ASJC Scopus subject areas

  • Urology


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