Introduction: Holmium Laser Enucleation of the Prostate (HoLEP) and Simple Prostatectomy (SP) are both surgical options for the treatment of large gland BPH. While multiple manuscripts compare the two procedures, there is limited data analyzing costs. Here we present current practice trends and a cost comparison between these procedures on a national level. Methods: The Healthcare Cost and Utilization Project National Inpatient Sample and Nationwide Ambulatory Surgery Sample databases from the year 2018 were queried. CPT codes and ICD-10PCS codes were used to identify patients undergoing HoLEP or SP. Data was examined to compare practice settings, total cost, and payer information. Categorical data was compared with Chi-squared test. Cost data was nonparametric and compared with Mann-Whitney U. A linear regression analysis was performed to determine factors associated with cost. SPSS version 28 was used for all statistical analysis. Results: More HoLEPs (5,782) were performed than SP (973). Most were performed at teaching institutions (HoLEP- 76.7%; SP- 80.0%). Medicare was the primary payer for both procedures (HoLEP- 66.3%; SP- 64.3%). Most HoLEP procedures were completed in the outpatient setting (87.8%) while most SPs were performed in the inpatient setting (94.3%, p<0.001). Median length of stay was longer for SP (HoLEP - 0, IQR 0; SP-3, IQR 2-4, p<0.001). The median cost for HoLEP was $26,689 (IQR: $19,292-$35,491) and SP was $51,250 (IQR: $34,683-$82,979; p<0.001). On linear regression analysis surgical type was an independent predictor of cost and HoLEP accounted for a $16,464 cost savings. Payer type was not a significant predictor of cost. HoLEPs were least commonly performed in the West (3.2%). HoLEPs were most expensive in the west ($43,960, p<0.001) and had a significantly longer hospital stay (2, p<0.001) Conclusions: HoLEP was performed more frequently and was significantly less expensive than SP. Surgery type was an independent predictor of total cost. A regional analysis suggests that HoLEPs performed at low volume centers may be more costly and result in longer hospital stays. HoLEP should be considered a cost-effective alternative to SP and referral to high volume centers may be considered. SOURCE OF Funding: none
