Cost Comparison of Interventional Treatments for Symptomatic Benign Prostate Hyperplasia in Israel

OBJECTIVES: Benign prostatic hyperplasia (BPH) is amongst the most prevalent and costly conditions affecting men over 50 years. When leading to bothersome lower urinary tract symptoms (LUTS), it can significantly impact quality of life. Surgery is the second-line treatment, when medication fails. Water vapor thermal therapy (WVTT) is a minimally invasive procedure for bothersome LUTS which offers similar clinical benefits to more invasive surgeries and may be cost saving. In this study, we compare the costs of different treatment options for BPH in Israel.

METHODS: We developed a cost consequence analysis from an Israeli public healthcare perspective that compares WVTT with Transurethral Resection of the Prostate (TURP), Photovaporisation of the Prostate (PVP), and Holmium Laser Enucleation of the Prostate (HoLEP). We replicated the model structure applied in a prior analysis submitted to the National Institute for Health and Care Excellence (NICE), England. The rates of adverse events and retreatment were assumed to be transferable. Differences in healthcare resource consumption were informed through a pragmatic literature review. Israel-specific cost data was sourced from literature, local price lists, and clinicians’ input.

RESULTS: Our cost analysis found that WVTT is cost-saving versus all included comparators, predicting savings of ILS 654, ILS 1,517, and ILS 144 per patient over 4 years when compared to TURP, PVP and HoLEP respectively. The budget impact analysis predicts that switching 8% of the 4,000 annually performed BPH procedures in Israel from TURP to WVTT may generate cost savings of ILS 415,000 over four years. Moreover, this shift may increase overall surgical capacity, by potentially freeing up 751 bed-days and 425 theatre hours per year.

Sensitivity analysis confirmed WVTT is cost-saving compared to TURP and PVP, with uncertain savings compared to HoLEP.

CONCLUSIONS: Adoption of WVTT in Israeli public hospitals is likely to be both, cost-saving and increasing overall surgical capacity.