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.
OBJECTIVE
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.


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.


CONCLUSIONS
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.
Nørby
B
B
Department of Surgery, Section of Urology, Kolding Hospital, Denmark.
Nielsen
H V
HV
Frimodt-Møller
P C
PC
D000368:Aged; D003362:Cost-Benefit Analysis; D005500:Follow-Up Studies; D006801:Humans; D006979:Hyperthermia, Induced / Q000191:economics* / Q000379:methods; D008297:Male; D008872:Microwaves / Q000627:therapeutic use*; D008875:Middle Aged; D011336:Probability; D011468:Prostatectomy / Q000191:economics* / Q000379:methods; D011470:Prostatic Hyperplasia / Q000191:economics* / Q000473:pathology / Q000628:therapy*; D018709:Statistics, Nonparametric; D020728:Transurethral Resection of Prostate / Q000191:economics*; D016896:Treatment Outcome