Holmium laser enucleation versus open prostatectomy for benign prostatic hyperplasia: an inpatient cost analysis.
OBJECTIVE
To compare the cost of open transvesical prostatectomy (OP) with that of holmium laser enucleation (HoLEP) in the treatment of bladder outlet obstruction (BOO) attributed to benign prostatic hyperplasia.


METHODS
From February to May 2004, 63 consecutive patients with symptomatic benign prostatic hyperplasia in a large prostate (70 to 220 g) and documented BOO were randomized to surgical treatment with OP (29 in group 1) or HoLEP (34 in group 2). All costs associated with the procedures during the hospital stay were recorded prospectively, and a cost-effectiveness analysis of the critical perioperative (ie, intraoperative and postoperative to hospital discharge) data was performed.


RESULTS
The cost analysis showed a mean perioperative cost of 2868.9 euros (3556.3 dollars) for group 1 and 2356.5 euros (2919.4 dollars) for group 2. A direct comparison analysis showed that the most significant cost factors were the operative time (average 16.1% and 25.1% to the cost of OP and HoLEP, respectively), operating room surgical setup/disposables, including laser fiber and resectoscope loop in group 2 (average 13.3% and 29.3% to the cost of OP and HoLEP, respectively), and length of postoperative hospital stay (average 53.3% and 32.0% to the cost of OP and HoLEP, respectively). Overall, the hospitalization cost of HoLEP was 9.6% less than that for OP.


CONCLUSIONS
Our data have demonstrated that HoLEP is associated with a significant hospital net cost savings compared with OP in patients undergoing surgery for symptomatic benign prostatic hyperplasia in large glands.
Salonia
Andrea
A
Department of Urology, University Vita-Salute San Raffaele, Scientific Institute San Raffaele Hospital, Milan, Italy. salonia.andrea@hsr.it
Suardi
Nazareno
N
Naspro
Richard
R
Mazzoccoli
Bruno
B
Zanni
Giuseppe
G
Gallina
Andrea
A
Bua
Lina
L
Scattoni
Vincenzo
V
Rigatti
Patrizio
P
Montorsi
Francesco
F
D000368:Aged; D003365:Costs and Cost Analysis; D006801:Humans; D053685:Laser Therapy / Q000191:economics*; D008297:Male; D011446:Prospective Studies; D011468:Prostatectomy / Q000191:economics* / Q000379:methods*; D011470:Prostatic Hyperplasia / Q000150:complications / Q000191:economics* / Q000601:surgery*; D001748:Urinary Bladder Neck Obstruction / Q000191:economics* / Q000209:etiology / Q000601:surgery*