title: The Continuing Story of the Cost-Effectiveness of Photoselective Vaporization of the Prostate versus Transuretheral Resection of the Prostate for the Treatment of Symptomatic Benign Prostatic Obstruction.
abstract: BACKGROUND
  In 2008, a UK assessment of technologies for benign prostatic obstruction concluded negatively about photoselective vaporization of the prostate (PVP), and the 2010 National Institute for Health and Care Excellence guidance caused several UK institutions to abandon PVP.
  
  
  OBJECTIVE
  To reassess the costs and effects of PVP versus transurethral resection of the prostate (TURP) on the basis of most recent data.
  
  
  METHODS
  The same model was used as in 2008. Transition probabilities were estimated using a Bayesian approach updating the 2008 estimates with data from two meta-analyses and data from GOLIATH, the latest and largest trial comparing PVP with TURP. Utility estimates were from the 2008 assessment, and estimates of resource utilization and costs were updated. Effectiveness was measured in quality-adjusted life-years gained, and costs are in UK pounds. The balance between costs and effects was addressed by multivariate sensitivity analysis.
  
  
  RESULTS
  If the 2010 National Institute for Health and Care Excellence analysis would have updated the cost-effectiveness analysis with figures from its own meta-analysis, it would have estimated the change in quality-adjusted life-years at -0.01 (95% confidence interval [CI] -0.05 to 0.01) instead of at -0.11 (95% CI -0.31 to -0.01) as in the 2008 analysis. The GOLIATH estimate of -0.01 (95% CI -0.07 to 0.02) strengthens the conclusion of near equivalence. Estimates of additional costs vary from £491 (£21-£1286) in 2008 to £111 (-£315 to £595) for 2010 and to £109 (-£204 to £504) for GOLIATH. PVP becomes cost saving if more than 32% can be carried out as a day case in the United Kingdom.
  
  
  CONCLUSIONS
  The available evidence indicates that PVP can be a cost-effective alternative for TURP in a potentially broad group of patients.
authors.affiliation: Department of Urology, Princess of Wales Hospital, Bridgend, Wales, UK.
authors.forename: J Andrew
authors.initials: JA
authors.lastname: Thomas
authors.affiliation: Department of Urology, Sant'Andrea Sapienza University, Rome, Italy.
authors.forename: Andrea
authors.initials: A
authors.lastname: Tubaro
authors.affiliation: Department of Urology, Frimley Park Hospital, Frimley, Camberley, Surrey, UK.
authors.forename: Neil
authors.initials: N
authors.lastname: Barber
authors.affiliation: Freeman Hospital Newcastle, Newcastle upon Tyne, UK.
authors.forename: Andrew
authors.initials: A
authors.lastname: Thorpe
authors.affiliation: Kleijnen Systematic Reviews, York, UK.
authors.forename: Nigel
authors.initials: N
authors.lastname: Armstrong
authors.affiliation: Department of Urology, University of Basel, Basel, Switzerland.
authors.forename: Alexander
authors.initials: A
authors.lastname: Bachmann
authors.affiliation: School for Health and Related Research, University of Sheffield, Sheffield, UK. Electronic address: b.a.vanhout@sheffield.ac.uk.
authors.forename: Ben
authors.initials: B
authors.lastname: Van Hout
mesh_terms: D003362:Cost-Benefit Analysis / Q000639:trends; D006801:Humans; D053685:Laser Therapy / Q000191:economics* / Q000639:trends; D008297:Male; D008390:Markov Chains; D011467:Prostate; D011469:Prostatic Diseases / Q000175:diagnosis / Q000191:economics* / Q000601:surgery*; D020728:Transurethral Resection of Prostate / Q000191:economics* / Q000639:trends; D016896:Treatment Outcome
keywords: NICE guidance; United Kingdom; benign prostatic obstruction; cost effectiveness analysis; health care