Comparing the Cost-Effectiveness of a Novel Minimally Invasive Surgical Therapy for Benign Prostatic Hyperplasia (BPH): A Swedish Perspective

OBJECTIVES: In Sweden, transurethral resection of the prostate (TURP) is a common surgical intervention for BPH. Whilst TURP is well-established and effective, it carries risk of adverse events and is commonly associated with multiple days hospital stay. These can impact both health utility and cost substantially. We sought to understand the cost-effectiveness of introducing a novel, minimally invasive surgical therapy into the public healthcare setting in Sweden.

METHODS: A semi-Markov model was developed to compare the second-generation temporary implantable nitinol prostatic device (temporary device) procedure with TURP and two other treatments available in Sweden: water vapour therapy (WVT) and transurethral microwave therapy (TUMT). Patients progressed through health states of the initial procedure, post-treatment, retreatment (with the same procedure or TURP), post-retreatment and death. A pragmatic literature search was conducted to find best available health utilities and costs for each event and health state. Treatment costs were modelled using national DRG prices.

RESULTS: Our base case analysis over a five year time horizon showed the temporary device procedure was dominant versus TURP, yielding 0.177 more QALYs with 72,978 SEK (Swedish Krona) less cost. The temporary device procedure was also dominant versus WVT, yielding comparable QALYs (0.034 more) but with 15,338 SEK less cost. When compared with TUMT, the temporary device procedure again yielded comparable QALYs (0.062 less), but with 41,068 SEK less cost, producing an ICER value for TUMT of 666,588 SEK (approximately €60,000) per QALY gained.

CONCLUSIONS: Our data suggest the temporary device is a cost-effective procedure for treating BPH in Sweden. The dominant position versus TURP is driven largely by lower initial treatment costs and greater health utility associated with fewer adverse events. The temporary device procedure is still likely to be considered cost-effective versus TUMT, given the accepted ICER range in Sweden for a disease of this severity.