Alizatos_EU_Genito.qxp 21/2/08 12:49 pm Page 9
mainly due to significantly shorter duration of catheterisation and
hospital stay.
3,4
A comparison among 105 men treated with TURP or
high-powered PVP laser showed similar financial costs for the two
treatments during hospital stay in Switzerland. Costs for the operation
room were significantly higher for TURP (1,639 versus 1,226 Swiss
francs [Sfr]). Costs for disposable materials (including laser fibre) were
significantly higher for PVP (1,775 versus 222 Sfr). Costs for post-
operative nursing (including post-operative irrigation solution) were
less for PVP (3,067 versus 3,547 Sfr).
4,5
In a study from Australia, despite the high cost of the equipment and
disposables, PVP was less expensive than TURP when performed as a
day case procedure (US$3,368 versus US$4,291). This was mainly due
to much shorter hospital stay and length of catheterisation and lower
complication rates.
3
Recently, the clinical outcomes and the cost characteristics of PVP,
microwave thermotherapy, transurethral needle ablation, ILC and
TURP were compared using a Markov decision model. In the model,
patients were followed for two years following the initial intervention.
The model included costs of initial treatment, follow-up care, adverse
events and re-treatment.
6
PVP resulted in the largest number of
beneficial changes in International Prostate Symptom Score (IPSS),
maximum urinary flow rates (Qmax) and quality of life scores at all
time-points evaluated. TURP and then ILC produced the next largest
number of beneficial changes. The largest difference between PVP and
TURP was observed for Qmax (per cent decrease from baseline at 24
months: 221 versus 89%).
The expected cost per patient at all three time points was lowest for PVP
(US$3,020 at six months, US$3,214 at 12 months and US$3,589 at 24
months). This was followed by ILC (US$3,573 at six months, US$3,965 at
12 months and US$4,754 at 24 months) and then TURP (US$4,030 at six
months, US$4,331 at 12 months and US$4,927 at 24 months). The
savings of PVP stemmed from lower rates of adverse events and re-
treatment than in the other procedures. Most costs at all time periods
were due to the initial procedural intervention, while only 6–30% of the
total cost was related to treatment of adverse events or to re-treatment.
6
Sensitivity analysis of the model showed that in order for the cost
of PVP to be equal to the cost of TURP, the re-treatment rate for
When morbidity was measured, the
comparison favoured photoselective
vaporisation of the prostate, mainly due
to significantly shorter duration of
catheterisation and hospital stay.
PVP needed to be 17%. This rate is more than three times the PVP
re-treatment rate reported in the literature.
2,3
The model also
showed that even with rates of adverse effects for the PVP laser at
the maximum observed values, the expected cost of the method
at 12 and 24 months would still be lower than that of all other
treatment modalities.
6
EUROPEAN GENITO-URINARY DISEASE 2007