OPERATING ROOM EFFICIENCY AND COST IMPLICATIONS OF THULIUM FIBER LASER VERSUS HOLMIUM:YAG LASER FOR PROSTATE ENUCLEATION: A TARGETED REVIEW, ANALYSIS, AND MODEL
Author(s)
Timothy Kelly, MBA, MSc1, Vy Giang, PharmD, MBA2, Ashley Taneja, BS2, MONICA TELINOIU, MBA, MS2;
1Becton Dickinson, Senior Director HEOR, Atlanta, GA, USA, 2Becton Dickinson, Franklin Lakes, NJ, USA
1Becton Dickinson, Senior Director HEOR, Atlanta, GA, USA, 2Becton Dickinson, Franklin Lakes, NJ, USA
OBJECTIVES: Endoscopic enucleation of the prostate (EEP) is a leading option for the surgical treatment of benign prostatic hyperplasia (BPH). EEP may be accomplished with different energy sources including bipolar electrical energy, holmium:YAG laser (HoLEP), thulium:YAG laser (ThuLEP), and thulium fiber laser (ThuFLEP). Thulium fiber lasers (TFL) with a wavelength of 1940 nm and a pulsed mode of action decrease the penetration depth during ThuFLEP allow increased laser energy absorption and immediate vaporization. This review and analysis seek to add clarity as to whether a specific laser modality for EEP provides greater efficiency with respect to operative duration and clinical outcomes.
METHODS: A targeted review of systematic reviews published 2021 through early 2026 (PubMed), evaluating no fewer than 5 studies comparing ThuFLEP to HoLEP and reporting total operative time, was conducted. Results on operative time reduction were synthesized and incorporated into an economic model to estimate the potential cost savings.
RESULTS: 9 systematic reviews were identified and reviewed. One systematic review, which examined 12 studies, 5 of which reported total operative time for both ThuFLEP and HoLEP, was analyzed. Across all included studies, operative time differences were aggregated to calculate a pooled mean reduction of 8.4 minutes for TFL procedures. This reduction was applied to an economic model based on standard operating room cost assumptions, yielding an estimated per-case cost savings of $411 (2025 USD). All 5 analyzed studies reported rates of post-procedure stress urinary incontinence (SUI). Rates of SUI were the same or lower in patients undergoing ThuFLEP compared to HoLEP in 4 of the 5 studies.
CONCLUSIONS: ThuFLEP, performed with TFL, may reduce total operating room time by approximately 8 minutes per case compared to HoLEP. That time savings represents a $411 per-case cost savings over HoLEP procedures. In addition, ThuFLEP may be associated with equal or lower rates of post-procedure SUI.
METHODS: A targeted review of systematic reviews published 2021 through early 2026 (PubMed), evaluating no fewer than 5 studies comparing ThuFLEP to HoLEP and reporting total operative time, was conducted. Results on operative time reduction were synthesized and incorporated into an economic model to estimate the potential cost savings.
RESULTS: 9 systematic reviews were identified and reviewed. One systematic review, which examined 12 studies, 5 of which reported total operative time for both ThuFLEP and HoLEP, was analyzed. Across all included studies, operative time differences were aggregated to calculate a pooled mean reduction of 8.4 minutes for TFL procedures. This reduction was applied to an economic model based on standard operating room cost assumptions, yielding an estimated per-case cost savings of $411 (2025 USD). All 5 analyzed studies reported rates of post-procedure stress urinary incontinence (SUI). Rates of SUI were the same or lower in patients undergoing ThuFLEP compared to HoLEP in 4 of the 5 studies.
CONCLUSIONS: ThuFLEP, performed with TFL, may reduce total operating room time by approximately 8 minutes per case compared to HoLEP. That time savings represents a $411 per-case cost savings over HoLEP procedures. In addition, ThuFLEP may be associated with equal or lower rates of post-procedure SUI.
Conference/Value in Health Info
2026-05, ISPOR 2026, Philadelphia, PA, USA
Value in Health, Volume 29, Issue S6
Code
EE511
Topic
Economic Evaluation
Disease
SDC: Urinary/Kidney Disorders, STA: Surgery