A cost-effectiveness analysis of pharmacotherapy versus prostatic urethral lift as initial therapy for patients with moderate benign prostatic hyperplasia

ABSTRACT

Aim

The objective of this study was to evaluate the cost-effectiveness of an upfront minimally invasive surgical procedure, the prostatic urethral lift (PUL), as an initial treatment for patients with moderate benign prostatic hyperplasia (BPH), against current first-line pharmacotherapy with combination medical therapy.

Method

A micro-simulation model was developed using TreeAge Pro to compare two treatment strategies – initial treatment with combination medical therapy (alpha-blocker + 5-ARI) versus an upfront prostatic urethral lift procedure. The impact on disease progression, costs, and quality-adjusted life-years (QALYs) was analyzed. A Markov model and probabilistic sensitivity analysis were used to estimate the costs and effects of the different strategies. The cost-effectiveness of the strategies at different willingness-to-pay (WTP) thresholds was then examined.

Results

Incremental costs (versus no prostatic urethral lift) were S$13,600 (1 year) and S$8,700 (5 years). Incremental QALYs were 0.07 (1 year) and 0.22 (5 years). An upfront PUL procedure was more expensive but also more effective than pharmacotherapy, with an incremental cost per QALY gain of approximately S$39,400. It is a cost-effective treatment option at the willingness-to-pay threshold of S$50,000.

Conclusion

Prostatic urethral lift is a cost-effective initial treatment option for men with moderate symptoms of benign prostatic hyperplasia.

KEYWORDS:

• Benign prostatic hyperplasia
• cost-effectiveness
• minimally invasive
• prostatic urethral lift

Declaration of interest

The authors have no relevant affiliations or financial involvement with any organization or entity with a financial interest in or financial conflict with the subject matter or materials discussed in the manuscript. This includes employment, consultancies, honoraria, stock ownership or options, expert testimony, grants or patents received or pending, or royalties.

Reviewer disclosures

Peer reviewers on this manuscript have no relevant financial or other relationships to disclose.

Data availability statement

All data generated or analysed during this study are included in this published article.

Author contributions

All authors contributed to the study conception and design. Material preparation and data acquisition were performed by J Tung; data analysis and interpretation were performed by J Tung and C Chen. All authors contributed to the development of the manuscript and approved the final version for publication.

Ethics approval

As this is a cost-effectiveness study, exemption was granted by the SingHealth Centralised Institutional Review Board, Reference 2020/2339.

Supplementary material

Supplemental data for this article can be accessed online at https://doi.org/10.1080/14737167.2023.2144237

Additional information

Funding

This paper was not funded.