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Pharmacotherapy vs. minimally invasive therapies as initial therapy for moderate-to-severe benign prostatic hyperplasia: a cost-effectiveness study

Prostate Cancer and Prostatic Diseases volume 26, pages 113–118 (2023)Cite this article

Subjects

Abstract

Background

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

Methods

In this model-based economic evaluation we simulated BPH progression in men (mean age 65 years, average International Prostate Symptom Score 16.6) over their lifetime and estimated healthcare costs (from the US public payer perspective) per quality-adjusted life year (QALY), discounted at 3% annually. 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: (1) initial pharmacotherapy with MIT as second-line, and transurethral resection of the prostate (TURP) or pharmacotherapy as third-line; (2) initial MIT (WVTT or PUL) with MIT again, TURP or pharmacotherapy as second-line, and TURP as third-line. Model was populated using data from the published literature. Probabilistic analyses were performed.

Results

Initial treatment with WVTT led to the highest QALYs (13.05) and the lowest cost ($15,461). The cumulative QALYs and lifetime costs were 12.92 QALYs and $20,280 for pharmacotherapy followed by WVTT, 12.87 QALYs and $22,424 for pharmacotherapy followed by PUL, 12.86 QALYs and $20,930 for initial treatment with PUL. In the cost-utility analysis, WVTT as initial treatment dominated all three strategies, i.e., generated more QALYs at a lower cost.

Conclusion

WVTT is an effective and cost-saving procedure, and may be an appropriate first-line alternative to pharmacotherapy for moderate-to-severe BPH patients who seek faster improvement and no lifelong commitment to daily medications.

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Fig. 1: Model structure (the figure was adopted and modified from Chughtai et al. [43]).
Fig. 2: Time to retreatment.
Fig. 3: The mean change in IPSS from the baseline over lifetime for all strategies compared.

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Data availability

All data generated or analyzed during this study are included in this published article (and its Supplementary files).

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Acknowledgements

The authors would like to thank Karen Bremner, research associate at THETA, for editing the manuscript.

Funding

Investigator-initiated research grant (unrestricted) from Boston Scientific. Study sponsor has no input into study design, analysis, interpretation, manuscript preparation.

Author information

Authors and Affiliations

  1. Toronto Health Economics and Technology Assessment Collaborative, University Health Network, Toronto, ON, Canada

    Yeva Sahakyan, Aysegul Erman & Beate Sander

  2. University of Montreal Hospital Center, Montreal, QC, Canada

    Naeem Bhojani & Kevin C. Zorn

  3. Weill Cornell Medicine, New York, NY, USA

    Bilal Chughtai

  4. Institute of Health Policy, Management, and Evaluation, University of Toronto, Toronto, ON, Canada

    Beate Sander

  5. Public Health Ontario, Toronto, ON, Canada

    Beate Sander

  6. Division of Urology Krembil Research Institute, University Health Network, Toronto, ON, Canada

    Dean S. Elterman

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Contributions

YS: conceptualization, methodology, resources, formal analysis, writing—original draft, writing—review and editing. AE: conceptualization, methodology, resources, validation, writing—review and editing. NB: conceptualization, writing—review and editing. BC: conceptualization, resources, writing—review and editing. KCZ: conceptualization, writing—review and editing. BS: supervision, methodology, conceptualization, writing—review and editing. DSE: funding acquisition, supervision, project administration, conceptualization, writing—review and editing.

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Correspondence to Dean S. Elterman.

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Competing interests

DSE: Consultant/investigator for Boston Scientific, Olympus, Procept, Prodeon, Urotronic, Zenflow; NB: Consultant/investigator for Boston Scientific, Olympus, Procept; BC: Consultant/investigator for Boston Scientific, Olympus, Procept, Prodeon, Urotronic, Zenflow; KCZ: Consultant/investigator for Boston Scientific, Procept; YS, AE, BS: no conflicts.

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Sahakyan, Y., Erman, A., Bhojani, N. et al. Pharmacotherapy vs. minimally invasive therapies as initial therapy for moderate-to-severe benign prostatic hyperplasia: a cost-effectiveness study. Prostate Cancer Prostatic Dis 26, 113–118 (2023). https://doi.org/10.1038/s41391-022-00561-2

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