Transurethral resection vs microwave thermotherapy of the prostate: a cost-consequences analysis.
OBJECTIVE
To compare the costs and outcome of high-energy transurethral microwave thermotherapy of the prostate (HE-TUMT) with transurethral resection of the prostate (TURP), as the former is considered to be the best minimally invasive method for managing lower urinary tract symptoms (LUTS) suggestive of benign prostatic hyperplasia (BPH).


METHODS
Between January 1996 and March 1997, 144 patients were randomized to treatment with HE-TUMT (78) using the Prostatron device and Prostasoft 2.5 software (EDAP Technomed, Lyon, France), or TURP (66). At baseline and during the annual follow-up, patients were evaluated by the International Prostate Symptom Score and uroflowmetry (maximum flow rate and postvoid residual volume). Kaplan-Meier survival analyses were used to calculate the cumulative risk of re-treatment. A cost-consequences analysis was performed based on the prospective measurement of healthcare use, with costs expressed as Netherland guilders (NLG).


RESULTS
During a 3-year follow-up period, the mean (95% confidence interval) risk of re-treatment was 22.9 (12.5-33.2)% and 13.2 (4.5-21.9)% for HE-TUMT and TURP, respectively (P = 0.215). The mean direct cost of treatment was 3450 (3444-3456) and 6560 (5992-7128) NLG for HE-TUMT and TURP, respectively. The mean total (including re-treatments), discounted (4%) 3-year cost for the HE-TUMT and TURP group was 5300 (4692-5908) and 7800 (7118-8482) NLG, respectively.


CONCLUSIONS
In this prospective randomized trial, HE-TUMT and TURP had a comparable 3-year risk of re-treatment. Healthcare expenditure on HE-TUMT, mainly because it is an outpatient treatment, was significantly lower than for TURP.
De La Rosette
J J M C H
JJ
Department of Urology, Academic Medical Centre, Amsterdam, the Netherlands. J.J.delaRosette@amc.uva.nl
Floratos
D L
DL
Severens
J L
JL
Kiemeney
L A L M
LA
Debruyne
F M J
FM
Pilar Laguna
M
M
D000368:Aged; D000553:Ambulatory Care / Q000191:economics; D003362:Cost-Benefit Analysis; D003631:Day Care, Medical / Q000191:economics; D005500:Follow-Up Studies; D006295:Health Resources / Q000191:economics; D006801:Humans; D006979:Hyperthermia, Induced / Q000191:economics* / Q000379:methods; D008297:Male; D008872:Microwaves / Q000627:therapeutic use*; D009426:Netherlands; D011446:Prospective Studies; D011470:Prostatic Hyperplasia / Q000191:economics / Q000601:surgery / Q000628:therapy*; D019233:Retreatment; D012307:Risk Factors; D016019:Survival Analysis; D020728:Transurethral Resection of Prostate / Q000191:economics* / Q000706:statistics & numerical data; D014570:Urologic Diseases / Q000191:economics / Q000628:therapy