Expanding treatments for lower urinary tract symptoms, secondary to benign prostatic enlargement. A capacity and budget impact analysis in four Nordic countries.

OBJECTIVES

This capacity and budget impact analysis considers implications of offering a more diversified benign prostate enlargement (BPE) surgical care offering from a healthcare payer perspective in Sweden, Denmark, Norway and Finland.

METHODS

A cohort simulation model compares 4-year treatment costs and capacity impact, including hospital bed-days and operating time, with Transurethral Resection of the Prostate (TURP), Holmium Laser Enucleation of the Prostate (HoLEP) using MOSES™Technology, photoselective vaporisation of the prostate (PVP) and Rezūm™ Water Vapour Therapy (WVTT). Current treatment choice is compared to a hypothetical scenario, where TURP-proportion is reduced to 50% and volumes of HoLEP, PVP and WVTT are increased. Deterministic sensitivity analysis (DSA) and probabilistic sensitivity analysis (PSA) considered uncertainty when varying all model inputs individually and simultaneously.

RESULTS

Reducing the proportion of TURP to 50% and shifting towards a more diversified surgical offering could save 590 bed-days, 2,281 theatre hours and SEK 14,020,153 in Sweden; 343 bed-days, 1,248 theatre hours and DKK 10,493,266 in Denmark; 267 bed-days, 1,032 theatre hours and NOK 9,329,844 in Norway and 576 bed-days, 1,181 theatre hours and 1,059,528€ in Finland per year. WVTT emerged as the lowest-cost procedure in all scenarios. Both DSAs and PSAs demonstrated outcome robustness.

CONCLUSION

The adoption of a more diversified surgical care offering for patients with BPE in the Nordics may free theatre time and hospital bed-days and create meaningful cost-savings, which off-set higher initial device cost. Economic considerations should not constitute a barrier to the adoption of a patient-centric surgical care offering for BPE patients in the Nordics.