OBJECTIVES

Benign prostatic hyperplasia (BPH) costs the US healthcare system over $1 billion annually. Convective water vapor energy therapy (WAVE; Rezum System) and prostatic urethral lift (PUL; UroLift System) are minimally invasive surgical treatment options for men with BPH experiencing moderate-to-severe lower urinary tract symptoms (LUTS). We estimated the budget impact to Medicare of WAVE versus PUL using long-term clinical outcomes.

METHODS

A budget impact model (BIM) was developed from a Medicare perspective over a 4-year time period. The BIM was populated with a cohort of males aged 63 years with an International Prostate Symptom Score (IPSS) of 22. WAVE and PUL clinical inputs were extracted from the Rezum II and LIFT trials at 4-years follow up. Procedural, adverse event, retreatment, follow-up and medication costs were based on 2019 Medicare payment rates and 2017 Medicare Part D Drug Spending (inflated to $2019). Scenario analyses were performed to explore the impact of different post-operative global payment periods for WAVE (90 days) and PUL (zero days). One-way sensitivity analysis was also performed.

RESULTS

WAVE had lower retreatment rates (10.9% vs. 24.6%) and lower total costs ($2,257 vs. $7,445) than PUL at 4 years. The 70% cost difference was predominantly driven by lower WAVE procedural ($1,689 vs. $5,617) and retreatment ($257 vs. $976) costs. WAVE remained cost saving relative to PUL in scenario analyses standardizing the global payment periods. Total costs for WAVE and PUL were $2,497 vs. $7,445 with a zero-day global period and $2,257 vs. $7,099 with a 90-day global period. WAVE remained cost saving relative to PUL when model parameters were varied by ±10%.

CONCLUSIONS

WAVE is less costly than PUL to Medicare for the treatment of BPH patients with moderate-to-severe LUTS. These findings provide compelling evidence for clinicians, payers and policy makers to help differentiate minimally invasive surgical treatments for BPH.