Cost-effectiveness of New Treatments for Benign Prostatic Hyperplasia: Results of a Randomized Trial Comparing the Short-term Cost-effectiveness of Transurethral Interstitial Laser Coagulation of the Prostate, Transurethral Microwave Thermotherapy and Standard Transurethral Resection or Incision of the Prostate

Objectives: To compare the short-term cost-effectiveness of ILC and TUMT with that of transurethral resection or incision of the prostate in patients with symptomatic benign prostatic hyperplasia. Material and Methods: One hundred and eighteen patients were randomized to ILC, TUMT and TUR-P/TUI-P in 2:2:1 fashion. The use of resources within the first 6 months of follow-up were measured and the cost of treatment for each patient were calculated. A few parameters, primarily related to the time spent by the staff, were measured only in a subgroup of patients. A cost-effectiveness analysis was performed based on the average calculated cost and change in I-PSS found in each group. For costly resources a sensitivity analysis was performed. Results: At 6 months the cost was lowest in the TUMT group and highest in the ILC group. The cost-effectiveness ratio (C/E) was 763 DKK/point reduction in I-PSS in the control group and 1.200 and 938 in the ILC and TUMT group, respectively. An incremental analysis demonstrated that TUR-P/TUI-P dominated ILC. In a similar comparison of the TUMT and the TUR-P/TUI-P group an incremental ratio of 170 DKK/extra point of reduction in I-PSS was found in the TUR-P/TUI-P group. Conclusion: In the short-term TUMT and TUR-P has comparable cost-effectiveness. TUR-P was slightly more effective than TUMT, but the cost was also slightly higher. In our set-up of ILC the short-term cost-effectiveness of ILC was inferior to that of TUR-P. Conclusions should be made with caution, since the follow-up at present is short.