Background: Recently, minimally invasive therapies (MITs) have become an alternative to surgery or pharmacotherapy to manage benign prostatic hyperplasia (BPH), offering symptom relief with a favorable safety profile. This study evaluated the cost-utility of MITs (water vapor thermal therapy [WVTT] and prostatic urethral lift [PUL]) compared to pharmacotherapy as initial treatment for patients with moderate-to-severe BPH.

Methods: We developed a simulation model to estimate BPH progression, assessed with the International Prostate Symptom Score, and healthcare costs (from the US Medicare payer perspective) per quality-adjusted life year (QALY) discounted at 3% annually. Men (mean age 65 years, average IPSS 16) were simulated over a lifetime horizon. Various clinical scenarios were evaluated given that most men undergo several lifelong therapies up to surgical intervention and potentially thereafter. As such, in the study model, men could receive up to three lines of therapy: i) initial pharmacotherapy with MIT as second-line, and TURP or pharmacotherapy as third-line; ii) initial MIT (WVTT or PUL) with MIT again, TURP or pharmacotherapy as second-line, and TURP as third-line. Therapy-specific adverse events were considered and applied, utilizing data from the published literature.

Results: Initial pharmacotherapy followed by PUL resulted in the highest lifetime costs ($22,422/person) and 12.87 QALYs. The cumulative lifetime costs and QALYs were $20,920/person and 12.86 QALYs for initial treatment with PUL, $20,273/person and 12.92 QALYs for pharmacotherapy followed by WVTT, and $15,434/person and 13.04 QALYs for initial treatment with WVTT. In the cost-effectiveness analysis, WVTT as initial treatment dominated all three strategies, i.e. generated more QALYs at a lower cost.

Conclusion: WVTT is an effective option for moderate-to-severe BPH and could be considered as a first-line treatment in selected patients. These findings will be beneficial for clinicians and health policy makers to define the optimal timing and cost-effective implementation of MITs for long-term BPH management.