Cost-effectiveness of Medical Versus Surgical Therapy for BPH

Purpose of ReviewBenign prostatic enlargement and obstruction may result in lower urinary tract symptom (LUTS) and have a negative impact on a patient's quality of life. The purpose of this review is to analyze different management options, specifically evaluating the cost-effectiveness of medical versus surgical therapy for BPH.Recent FindingsWe performed a detailed review comparing various studies regarding the cost-effectiveness of different management options that were conducted in the last 5years. When comparing monotherapy with combination therapy in medical treatments, the latter was found to be more cost-effective. Branded combined medical therapies were found to be much more expensive than generic medical therapies but demonstrated the same therapeutic outcome. When looking at operative options, specifically among the transurethral surgeries, there are more invasive options, including mono/bipolar transurethral resection of prostate (TURP) and laser vaporization and there are less invasive modalities (MIST) such as Urolift, Rez<umacron>m, transurethral microwave thermotherapy (TUMT), and transurethral needle ablation (TUNA). The findings demonstrated the cost of the more invasive options depended on whether the procedure was conducted as an inpatient or outpatient, with inpatient surgeries being the more expensive. In this context, GreenLight PVP, being performed as an outpatient procedure, was less expensive than TURP. Both of them provided the best relief in BPH symptoms but were found to have a higher incidence of side effects. Accordingly, it has been estimated the cost of MIST to be not only cheaper (except Urolift) than invasive transurethral options, but noted to have fewer side effects, especially in terms of ejaculatory dysfunction.SummaryAlthough combination generic medical therapy has been shown to be the least costly option, when invasive surgical management, such as TURP or GreenLight PVP as the most expensive, cost by itself is not the only metric to assess a BPH therapy. The more valuable criterion, such as cost-effectiveness, must be examined. In this light, MIST and especially Rez<umacron>m do appear to have a cost-effectiveness advantage over the other procedures due to its lower price and fewer side effects, while providing similar clinical efficacy.