Multicenter study of costs associated with GreenLight XPS 180W versus transurethral resection of the prostate for benign prostatic hyperplasia (BPH), "Beyond the Abstract," by Ángel Sanz-Granda

BERKELEY, CA (UroToday.com) - Benign prostatic hyperplasia (BPH) is a prevalent health problem in today's aging male population. For some time, the gold standard treatment option for BPH has been transurethral resection of prostate (TURP), showing good outcomes. In recent years, a new procedure (120W Green laser) has been used with similar efficacy^{[1, 2, 3]} but at lower cost.^{[4, 5]} This new surgical treatment has meant a better allocation of the always limited health resources. Currently, a new and more potent procedure, 180W Green laser (GL-XPS), has appeared. Therefore, its efficiency has to be analyzed in order of to allocate health resources in the most efficient way.

For assessing the efficiency of GL-XPS, we estimated the 3-month cost of both technologies, TURP (n: 40) and GL-XPS (n: 39,) from the data of all the patients of 4 Spanish hospitals who were operated (Table 1) using a mathematical model. Briefly: Ctotal = ΣC(I,t) = Σq(I,t) * p(I,t), using a bottom-up method and considering the quantity (q) of each resource used (i) for each phase (t). As a Spanish National Health Service perspective was adopted, only direct costs were included.

To estimate the total cost per patient (Table 2), three periods were analyzed separately: pre-surgical phase (from initial surgical consultation until the surgical procedure), surgical phase (covering only the procedure), and post-surgical phase (evaluating from operating room exit until the following 3 months (Tables 3, 4). We carried out a bootstrapping resample to evaluate the variability of results and to calculate the 95% confidence interval of the mean differences.

Results showed a statistically significant savings of 121 € (CI 95%: 91; 151) per patient who underwent GL-XPS. The main determinant of this difference was found in the post-surgical phase because of shorter hospital stay for GL-XPS patients (1.31 days, range: 0.1-0.22 and 4.05 days, range: 3.5-5.5, respectively). When there is no hospital stay after the GL-XPS procedure, as it has been showed with 120W GL by means of ambulatory surgery,^[6] the cost reduction reaches upwards of 700 € per patient in the first 3 months. However, we state some limitations such as the small size of the analyzed sample. Therefore we have performed a bootstrap resampling analysis (or the influence of the variability of medical practice), which we have tried to solve by a multicenter study.

In conclusion, this study, carried out in 4 Spanish hospitals, shows a reduction in costs by using the new 180W Green Light instead TURP in the treatment of lower urinary tract symptomatology secondary to benign prostatic hyperplasia, because it is associated with a shorter hospital stay. The cost of the new health technology is offset by shorter hospital stays, improving the efficiency of the resources used and patients’ welfare.

References:

1. Capitán C, Blázquez C, Martín D, Hernández V, de la Peña E, Llorente C. GreenLight HPS 120-W Laser Vaporization versus transurethral resection of the prostate for the treatment of lower urinary tract symptoms due to benign prostatic hyperplasia: a randomized clinical trial with 2-year follow-up. Eur Urol.2011;60:734-49
2. Ansari Al, Younes A, Sampige N, Al-Rumaihi V, Ghafouri K,Gul A, et al. GreenLight HPS 120-W Laser Vaporization versus transurethral resection of the prostate for treatment of benign prostatic hyperplasia: a randomized clinical trial with midterm follow-up. Eur Urol. 2010;58:349-55
3. Lukacs B, Loeffler J, Bruyère F, Blanchet P, Gelet A, Coloby P, et al. Photoselective vaporization of the prostate with GreenLight 120-W laser compared with monopolar transurethral resection of the prostate: A multicenter randomized controlled trial. Eur Urol. 2012;61:1165-73.4
4. Sanz-Granda A. (Proyectos de Farmacoeconomía) Análisis de costes a corto plazo de la vaporización fotoselectiva de la próstata mediante GreenLight-Photovaporization - HPS 120 system. Informe final American Medical Systems, Inc. (EE. UU.);2009
5. Benejam JM, Sanz-Granda A, García-Miralles R, Severa A, Pons J. Análisis coste efectividad a 2 años del tratamiento quirúrgico de la hiperplasia benigna de próstata mediante vaporización fotoselectiva de la próstata con GreenLight-Photo Vaporization120 W versus resección transuretral de la próstata. Actas Urol Esp. 2013,http://dx.doi.org/10.1016/j.acuro.2013.09.012 (in press).
6. Benejam-Gual J, Díez-Caballero F, García-Miralles R, Servera Ruiz de Velasco A. Fotovaporización prostática láser GreenLightHPS en régimen de cirugía mayor ambulatoria. Actas Urol Esp. 2010;34:170-5.

Written by:
Ángel Sanz-Granda as part of Beyond the Abstract on UroToday.com. This initiative offers a method of publishing for the professional urology community. Authors are given an opportunity to expand on the circumstances, limitations etc... of their research by referencing the published abstract.

Proyectos de Farmacoeconomía, Navacerrada, Madrid, España.

Multicenter study on costs associated with two surgical procedures: GreenLight XPS 180W versus the gold standard transurethral resection of the prostate - Abstract

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