The cost-effectiveness of thulium laser transurethral vaporesection of the prostate versus transurethral resection of the prostate
BAUS ePoster online library. Ahern A. Jun 25, 2019; 259588; P9-2
Aideen Ahern
Aideen Ahern
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Introduction: Transurethral resection of the prostate (TURP) is the most common procedure for benign prostatic obstruction (BPO) in the UK. New technologies are emerging to rival TURP, such as transurethral vaporesection of the prostate (ThuVARP). The UNBLOCS randomised controlled trial conducted within seven UK centres demonstrated similar outcomes of ThuVARP compared with TURP, here we estimate the within trial cost-effectiveness of TURP versus ThuVARP.
Patients and Methods: Secondary care resource-use related to surgery and follow-up were collected from hospital records and trial participants for 1-year post surgery and valued using UK reference costs. QALYs (quality-adjusted-life-years) were calculated from the EQ-5D-5L questionnaire. Total adjusted mean costs, QALYs and incremental Net Monetary benefit values were calculated. Cost-effectiveness acceptability curves (CEAC) and sensitivity analyses addressed uncertainty.
The total adjusted mean secondary care NHS cost in the TURP arm (£4185) was £71 (95% CI of -£486 to £343) lower than the ThuVARP arm (£4256). The ThuVARP operation took on average 20 minutes longer than the TURP procedure. The adjusted mean differences between the arms were similar in terms of Quality Adjusted Life Years (QALYs) (0.01 favouring TURP, 95% CI of -0.02 to 0.04). At the £20,000 per QALY NICE willingness to pay threshold there is an 81% probability that TURP is the cost-effective option compared with ThuVARP.
Conclusion: The expected reduction in costs of ThuVARP resulting from its ability to be done as a daycase did not materialise. Cost-effectiveness confirmed the conclusion from the effectiveness outcomes that TURP remains the gold standard procedure.
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