Benign prostatic hyperplasia (BPH) is common in older men affecting 40% of men in their fifties. If the enlarged gland begins to press upon the urethra and to interfere with urination, then treatment may be needed. Transurethral resection of the prostate (TURP) is a minimally invasive treatment that has became the gold standard for patients who are unwilling to remain on medication or in whom medical therapy failed. Recently a minimally invasive surgery treatment has shown similar results compared to TURP, transurethral needle ablation of the prostate (PROSTIVA®). OBJECTIVES: To carry out an economic evaluation of PROSTIVA® vs. TURP in non-drug respondent BHP patients in the Spanish setting. METHODS: A Markov model was developed in order to simulate the clinical and economical consequences of using PROSTIVA® or TURP in BHP. Four health states were considered: Intervention, therapeutic success, non-therapeutic success and permanent adverse events through a cost-effectiveness analysis. Clinical and economical data were retrieved from published clinical trials and validated by a clinician experienced in the BHP management. Perspective of the analysis was the National Health System perspective, so only direct costs were included. The time horizon was 15 years with 6 months cycles, so clinical and economical results were discounted at a 3% per year. A probabilistic sensitivity analysis (PSA) was performed in order to check the variability in the model results. All uncertain variables included were included in PSA. RESULTS: Mean cost per patient with PROSTIVA® was 1207€ (p=0.00) less than patients treated with TURP, but with a decrement 0.42 QALYs (p=0.00), which leads us to an ICER of 2860 €/QALYs. Sensitivity analyses have shown consistent results across changes in all variables. CONCLUSION: PROSTIVA® compared to TURP has shown to be an efficient therapy for non-drug respondents BHP patients in Spain, with an ICER below accepted thresholds.