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- Title
Photovaporization of the prostate with GreenLight™ laser 180 W XPS versus transurethral resection of the prostate with monopolar energy for the treatment of benign prostatic enlargement: a cost-utility analysis from a healthcare perspective.
- Authors
Caicedo, Juan Ignacio; Taborda, Alejandra; Robledo, Daniela; Bravo-Balado, Alejandra; Domínguez, Cristina; Trujillo, Carlos Gustavo; Cataño, Juan Guillermo; Campos Hernández, Jonathan; Londoño Trujillo, Darío; Plata, Mauricio
- Abstract
Purpose: To assess the cost-utility of the photovaporization of the prostate (PVP) with GreenLight™ laser 180 W XPS compared to transurethral resection of the prostate with monopolar energy (M-TURP) for lower urinary tract symptoms (LUTS) due to benign prostatic enlargement (BPE) from a healthcare perspective in Colombia. Methods: We designed a Markov model to compare four health states following treatment with either PVP or M-TURP to estimate expected costs and outcomes. We used the results of the only randomized clinical trial published to date comparing PVP versus M-TURP to estimate surgical outcomes, complications, re-operation and re-intervention rates. Time horizon was defined at 2 years with four cycles of 6 months each. Resource-use estimation involved a random selection of clinical records from a local institution and cost list from public healthcare system. Costs were obtained in Colombian pesos and converted to US dollars. Threshold was defined at three-times the Colombian gross domestic product (GDP) per capita. Quality-adjusted-life-years (QALYs) were used based on the utilities of the available literature. Uncertainty was analyzed with deterministic and probabilistic models using a Monte Carlo simulation. Results: Patients who underwent PVP gained 1.81 QALYs compared to 1.59 with M-TURP. Costs were US$6797.98 and US$7777.59 for M-TURP and PVP, respectively. Incremental cost-effectiveness ratio was US$4452.81 per QALY, favoring PVP as a cost-effective alternative in our context. Conclusions: In Colombia, with current prices, PVP is cost-effective when compared to M-TURP for LUTS due to BPE for a 2-year time horizon.
- Subjects
COLOMBIA; TRANSURETHRAL prostatectomy; BENIGN prostatic hyperplasia; COST effectiveness; THERAPEUTICS; PROSTATE; MONTE Carlo method
- Publication
World Journal of Urology, 2019, Vol 37, Issue 5, p861
- ISSN
0724-4983
- Publication type
Article
- DOI
10.1007/s00345-018-2425-1