OBJECTIVES

Prostatic urethral lift (PUL) and convective water vapor thermal therapy (WVTT) are emerging minimally invasive treatment options for benign prostatic hyperplasia (BPH) that can be performed in an office-based setting. Yet, some private payers in Alabama, New Jersey, New York, Oregon, Pennsylvania, and Washington of the United States provide limited coverage for WVTT. This study examined the budget impact of PUL compared to WVTT on private payers in these 6 states.

METHODS

An Excel-based Markov model was developed to examine the budget impact of PUL and WVTT for men with lower urinary tract symptoms secondary to BPH in 6 states of the United States over a 5-year time horizon. The model was populated with a cohort of men with a mean age of 63 years and an International Prostate Symptom Score of 22. We obtained clinical inputs from PUL and WVTT randomized controlled trials. Private payers typically benchmark their reimbursement with Medicare reimbursement rates. Thus, the weighted average of 2021 Medicare reimbursement was used as a proxy for procedural and adverse event costs for each state. PUL and WVTT procedures were assumed to occur in an office setting for procedural cost estimates.

RESULTS

The total costs of PUL at 1 year ranged from $5,690 to $7,324 in Alabama and New Jersey, respectively, compared to $1,829 and $2,330 for WVTT, reflecting a threefold higher cost for PUL than WVTT in the 6 states. The cost difference between the two treatments continued to diverge in years 2-5. For the two western states, the total costs of PUL at 5 years were $4,905 higher than WVTT in Oregon and $5,350 higher than WVTT in Washington.

CONCLUSIONS

WVTT provided short-term and long-term cost-savings for private payers in these 6 states when compared to PUL. These results should be considered in BPH surgical treatment coverage decisions.