Cost-effectiveness analysis at 2 years of surgical treatment of benign prostatic hyperplasia by photoselective vaporization of the prostate with GreenLight-PhotoVaporization 120 W versus transurethral resection of the prostate

IntroductionTransurethral resection of the prostate is the gold standard of surgical treatment of lower urinary tract symptoms associated to benign prostate hyperplasia. The new GreenLight PhotoVaporization has been shown to be an alternative that is as effective for this condition as the transurethral resection of the prostate.ObjectivesTo compare the efficiency of GreenLight PhotoVaporization 120 W versus transurethral resection of the prostate in the treatment of benign prostate hyperplasia (BPH) in a 2-year time horizon from the Spanish health service perspective.MethodsA cost utility analysis was performed retrospectively with the data from 98 patients treated sequentially with transurethral resection of the prostate (n: 50) and GreenLight PhotoVaporization 120 W (n: 48). A Markov model was designed to estimate the cost (2012€) and results (quality adjusted life years) in a 2-year time horizon.ResultsThe total cost associated to GreenLight PhotoVaporization 120 W treatment was less (3377€; 95% CI: 3228; 3537) than that of the transurethral resection of the prostate (3770€; 95% CI: 3579; 3945). The determining factor of the cost was the surgical phase (difference: −450€; 95% CI: −625; −158) because admission to hospital after surgery was not necessary with the GreenLight-PhotoVaporization.ConclusionsSurgical treatment of BPH patients with GreenLight-PhotoVaporization 120 W is more efficient than transurethral resection of the prostate in the surgical treatment of benign prostate hyperplasia as it has similar effectiveness and lower cost (−393€; 95% CI: −625; −158).

ResumenIntroducciónEl gold standard del tratamiento quirúrgico de la sintomatología del tracto urinario inferior asociado a la hiperplasia benigna de próstata ha sido la resección transuretral de la próstata; GreenLight-PhotoVaporization ha demostrado ser una alternativa quirúrgica tan efectiva como aquella.ObjetivoAnalizar la eficiencia comparada, en un horizonte temporal de 2 años, de GreenLight-PhotoVaporization 120 W respecto de la resección transuretral de la próstata en el tratamiento quirúrgico de la hiperplasia benigna de próstata desde la perspectiva del sistema de salud de España.MétodosSe realizó un análisis de coste utilidad a partir de los resultados obtenidos retrospectivamente en 98 pacientes intervenidos secuencialmente mediante resección transuretral de la próstata (n: 50) y GreenLight-PhotoVaporization 120 W (n: 48). Se utilizó un modelo de Markov para estimar el coste (€, 2012) y los resultados (años de vida ajustados a calidad) tras un seguimiento de 2 años.ResultadosEl coste total asociado al tratamiento con GreenLight-PhotoVaporization 120 W fue inferior (3.377€; IC 95%: 3.228; 3.537) al de la resección transuretral de la próstata (3.770€; IC 95%: 3.579; 3.945). El determinante del coste se presenta en la fase quirúrgica (diferencia: −450€; IC 95%: −625; −158) debido a que GreenLight-PhotoVaporization 120 W no precisaba ingresar al paciente tras la cirugía.ConclusionesEl tratamiento quirúrgico de los pacientes con HBP mediante GreenLight-PhotoVaporization 120 W muestra mayor eficiencia respecto de la resección transuretral de la próstata al observarse una efectividad similar y un coste inferior (−393€; IC 95%: −625; −158).