OBJECTIVES: Benign prostatic hyperplasia (BPH) is a highly prevalent and costly health condition among men aged 50 or older. Convective water vapor energy therapy (WAVE) and prostatic urethral lift (PUL) are safe and effective minimally invasive surgical treatment options for men with BPH experiencing moderate-to-severe lower urinary tract symptoms (LUTS). Using long term clinical trial data, we estimated the cost-effectiveness of WAVE compared to PUL.

METHODS: An Excel-based Markov model was developed to evaluate the cost-effectiveness of WAVE (Rezum System) versus PUL (UroLift System with an average of 4.9 implants) from a U.S. Medicare perspective over a 4-year time horizon. The model was populated with a cohort of males with a mean age of 63 years and an International Prostate Symptom Score (IPSS) of 22. Efficacy and safety data were extracted from WAVE and PUL randomized controlled trials (Rezum II Study and LIFT Study, respectively). Utility values were assigned using IPSS and BPH severity levels. Procedural and adverse event-related costs were based on 2019 Medicare reimbursement rates. One-way and probabilistic sensitivity analyses (PSAs) were performed.

RESULTS: At 4 years, WAVE was associated with lower retreatment rates (10.9% vs 24.6%), greater quality-adjusted life-years (QALYs) (3.548 vs 3.489) and lower total costs ($2,269 vs $7,109) compared with PUL. Based on these findings, WAVE was the dominant (more effective and less costly) treatment. The PSA demonstrated that WAVE was less expensive than PUL 100% of the time and associated with higher QALYs more than 95% of the time.

CONCLUSIONS: WAVE had a lower retreatment rate and was cost saving compared to PUL for the minimally invasive treatment of moderate-to-severe LUTS associated with BPH. Given the robustness of these findings, it is highly likely that WAVE would also be cost saving from a commercial payer perspective.