Medical therapy versus transurethral resection of the prostate (TURP) for the treatment of symptomatic benign prostatic enlargement (BPE): a cost minimisation analysis

• Published in: World journal of urology Vol. 37; no. 5; pp. 873 - 878
• Main Authors: Davis, Niall F., Jack, G. S., Witjes, W. P., Bjartell, A., Caris, C., Patel, A., de la Taille, A., Lawrentschuk, N., Bolton, D. M., Tubaro, A.
• Format: Journal Article
• Language: English
• Published: Berlin/Heidelberg Springer Berlin Heidelberg 01-05-2019; Springer Nature B.V
• Subjects: Aged; Aged, 80 and over; Benign; Benign prostatic enlargement; Benign prostatic hyperplasia; BPE; BPH; Clinical Medicine; Cost minimisation analysis; Costs and Cost Analysis; Drug Therapy, Combination; Finasteride - economics; Finasteride - therapeutic use; France; Germany; Humans; Italy; Klinisk medicin; Male; Medical and Health Sciences; Medicin och hälsovetenskap; Medicine; Medicine & Public Health; Middle Aged; Nephrology; Oncology; Original Article; Patients; Prostate; Prostatic Hyperplasia - economics; Prostatic Hyperplasia - therapy; Spain; Tamsulosin - economics; Tamsulosin - therapeutic use; Transurethral Resection of Prostate - economics; United Kingdom; Urologi och njurmedicin; Urological Agents - economics; Urological Agents - therapeutic use; Urology; Urology and Nephrology; Italy; United Kingdom; France; Germany; Spain; Benign prostatic hyperplasia; Cost minimisation analysis; BPH; Benign prostatic enlargement; BPE
• ISSN: 0724-4983; 1433-8726
• DOI: 10.1007/s00345-018-2454-9

Purpose
A cost minimisation analysis compares the costs of different interventions’ to ascertain the least expensive over time. We compared different prostate targeted drug treatments with TURP to identify the optimal cost saving duration of a medical therapy for symptomatic benign prostatic enlargement (BPE).
Methods
The
Evolution
registry is a prospective, multicentre registry, conducted by the European Association of Urology Research Foundation (EAUrf) for 24 months in 5 European countries.
Evolution
was designed to register the management of symptomatic BPE in clinical practice settings in 5 European countries. Direct cost evaluation associated with prostate targeted medical therapies and TURP was also recorded and analysed.
Results
In total, 1838 men were enrolled with 1246 evaluable at 24 months. Medical therapies were more cost saving than TURP for treatment durations ranging from 2.9 to 70.4 years. Cost saving depended on both medication class and individual country assessed. Daily tamsulosin monotherapy was more cost saving than TURP for ≤ 13.9 years in Germany compared to ≤ 32.7 years in Italy. Daily finasteride monotherapy was more cost saving for ≤ 5.9 years in France compared to ≤ 36.9 years in Spain. Combination therapy was more cost saving for ≤ 5.9 years for Italian patients versus ≤ 13.8 years in Germany.
Conclusions
BPE medical management was more cost saving than TURP for different specific treatment durations. Information from this study will allow clinicians to convey medical and surgical costs over time, to both patients and payors alike, when considering BPE treatment.