Category: Epidemiology, Health Policy, Socioeconomics & Outcomes
Introduction & Objective : To compare outcomes and costs after treatment of benign prostatic hyperplasia (BPH) with transurethral resection of the prostate (TURP) or prostatic urethral lift (PUL).
Methods : We searched the literature for reports on PUL from 2010 onwards. We were also granted access to search data for England in the National Health Service Hospital Episode Statistics (HES) database and The Health Improvement Network (THIN) at the record level to identify hospitalisation and treatment rates for TURP between January 2010 and December 2016.
Results : In 2016/17, 24,385 elective TURP procedures were done, with an average hospital stay of 2–3 days. The mean cost per procedure was £2,869 (IQR £2,422–3,138; total ~£67 million). The most frequent complications of TURP are ejaculatory dysfunction (≥65%), erectile dysfunction (10%), urethral stricture (4–7%), infection (5–6%), bleeding requiring transfusion (2–5%), and incontinence (3%). Over 5 years (2010–15) complications led to 70,000 hospital spells and payer costs of £109 million, which is likely to increase. Persistent lower urinary tract symptoms (LUTS) leads to restarting of drug therapy in 14–21% within 1 year. The average mean cost per PUL procedure was similar to that for TURP (£2,405 in 2015), but no hospital stay or follow-up visits are required. Adverse events are mild to moderate and most resolve in 2–4 weeks with minimal need for complication-associated hospital treatment. LUTS improvement rates are comparable to those for TURP but are more rapid and remain stable at 5 years. Erectile and ejaculatory function are fully preserved. With a conservative estimate of 50% reduction in complications and 50% adoption in patients who would otherwise undergo a TURP procedure, we estimate that £27 million per year could be saved by reductions in complications alone.
Conclusions : Increased use of PUL would substantially reduce costs currently associated with TURP.
Oliver Kayes– Urologist, LTHT, Leeds, England, United Kingdom