Mind the Gaps: Adoption and Underutilization of Holmium Laser Enucleation of the Prostate in the United States from 2008 to 2014

• Published in: Journal of endourology Vol. 34; no. 7; p. 770
• Main Authors: Robles, Jennifer, Pais, Vernon, Miller, Nicole
• Format: Journal Article
• Language: English
• Published: United States 01-07-2020
• Subjects: Aged; Holmium; Humans; Laser Therapy; Lasers, Solid-State - therapeutic use; Male; Medicare; Prostate - surgery; Prostatic Hyperplasia - surgery; Retrospective Studies; Transurethral Resection of Prostate; Treatment Outcome; United States; United States; transurethral resection of prostate/trends; prostatic hyperplasia/surgery; lasers/supply and distribution; benign prostatic hyperplasia
• ISSN: 1557-900X
• DOI: 10.1089/end.2019.0603

There is increasing recognition of the advantages of holmium laser enucleation of the prostate (HoLEP) for benign prostatic hypertrophy (BPH) treatment in the United States but relatively little is known about the extent of HoLEP adoption over time. This study aims to assess national HoLEP adoption rates and regional trends from 2008 to 2014.
We retrospectively analyzed a data set of 100% Medicare claims to determine the rate of U.S. HoLEP adoption in 2008, 2011, and 2014. Rates were adjusted by age and race and stratified by hospital referral region (HRR). Linear and logistic regression models were used to assess for trends in HoLEP adoption over time.
Total U.S. BPH cases decreased 24% from 2008 to 2014 and HoLEP cases increased significantly from 1086 (2008) to 3368 (2014). Despite this, HoLEP accounted for just 4% of total BPH cases in 2014. In 2008, 28/306 (9%) of HRRs recorded >10 HoLEP cases per year. This increased to 89 HRRs (29%) in 2011 but stabilized at 94 HRRs (31%) in 2014. In 2014, over 50% of states still had only 0 to 1 sites doing 10+ HoLEP cases per year.
Based on this 100% sample of Medicare claims from 2008 to 2014, surgical BPH treatment volume has decreased, while HoLEP volume and regional adoption have tripled. However, rates of HoLEP remain extremely low at just 4% of all BPH procedures in 2014, and large regional gaps in care exist. These data indicate that HoLEP remains substantially underutilized and the majority of regions still lack access to centers performing >10 HoLEP cases per year.