Presented by: Kevin Wymer MD
Mayo Clinic

Introduction

Despite the high prevalence of benign prostatic hyperplasia (BPH) treatment and its significant economic impact, limited data are available comparing the financial burden of specific surgical interventions.

Materials

We identified commercially insured men with a diagnosis of BPH who underwent a procedure of interest (SP, TURP, HoLEP, PVP, PUL, or WVTT) between 2015-2021 with the OptumLabs Data Warehouse. Primary outcome was total healthcare costs (THC) which included both patient out-of-pocket (OOP) and health plan paid (HPP) costs for the index procedure and combined follow-up years 1-5. A generalized linear model was used to estimate adjusted costs controlling for demographic and clinical characteristics. Patients undergoing WVTT were excluded from extended follow-up analyses due to limited data.

Results

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Among 25,407 patients with BPH, 10,117 (40%) underwent TURP, 6,353 (25%) underwent PUL, 5,411 (21%) underwent PVP, 1,319 (5%) underwent SP, 1,243 (5%) underwent WVTT, and 964 (4%) underwent HoLEP. Index procedure costs varied significantly with WVTT being the least costly [THC: $2,637 (95% CI: $2,513 – $2,761)], and SP being the costliest [THC: $14,423 (95% CI: $12,772 – $16,075)]. For aggregate index and 5-year follow-up costs, HoLEP ($31,926 [95% CI: $29,704–$34,148]) was the least costly and PUL ($36,596 [95% CI: $35,369-37,823]) was the costliest (Figure).

Conclusion

BPH surgical treatment is associated with significant system-level healthcare costs. The level of impact varies between procedures. Minimally invasive options, such as WVTT, may offer initial cost reductions; however, HoLEP and SP are associated with lower follow-up costs.

Funding

This work was supported in part by the Mayo Clinic Robert D. and Patricia E. Kern Center for the Science of Health Care Delivery

Co-Authors

Viengneesee Thao, PhD
Mayo Clinic

Gopal Narang, MD
University of North Carolina

Vidit Sharma, MD
Mayo Clinic

Bijan Borah, PhD
Mayo Clinic

Nicolette Payne, MD
Mayo Clinic

Victoria Edmonds, MD
Mayo Clinic

Mouneeb Choudry, MD
Mayo Clinic

Scott Cheney, MD
Mayo Clinic

Mitchell Humphreys, MD
Mayo Clinic