Budget Impact of a Minimally Invasive Surgical Treatment for Benign Prostatic Hyperplasia in Australian Public Hospitals

OBJECTIVES: With the increasing number of men with benign prostatic hyperplasia (BPH), Australian public hospitals face challenges including long waiting lists for transurethral resection of the prostate (TURP), extended hospital stays due to post-operative catheterization, and the risk of catheter-related infection, all of which could be addressed by offering patients minimally invasive surgical treatments (MISTs) in an outpatient setting.

METHODS: Over a one-year period, an Excel-based budget impact model was used to compare a MIST with a temporarily implanted nitinol device compared to TURP in a public hospital setting. Patients had either monopolar (96%) or bipolar (4%) TURP (N=3643). It was assumed that 10% of all TURP patients could have the MIST performed in an outpatient setting instead of TURP. Clinical, resource and cost inputs were sourced from the literature.

RESULTS: In the assumed scenario where 10% (364) of TURP patients were treated with a MIST using a temporarily implanted nitinol device rather than TURP, the total estimated costs for the MIST and TURP procedures conducted in Australian public hospitals were A$3,905 and A$11,908, respectively. The overall cost of treating 10% (364) of TURP patients with a MIST using a temporarily implanted nitinol device rather than TURP was -A$2,915,336 (a 6.7% reduction in total healthcare costs). In terms of resource use, a MIST using a temporarily implanted nitinol device saved 372 hours of operating room (OR) time, 1905 hours of healthcare professional time (urologists, anaesthesiologists, nurses, and support workers), and 917 post-operative hospital bed days (8.7%, 7.4%, and 11.11%, respectively).

CONCLUSIONS: Compared to TURP, a MIST using a temporarily implanted nitinol device may enable Australian public hospitals to shorten waiting lists for eligible patients with BPH without compromising clinical outcomes or increasing costs. The healthcare resources saved (OR time, staff, and hospital beds) may also enable more patients with BPH to be treated.