Prostate Artery Embolization and Minimally Invasive Urologic Procedures for Benign Prostatic Hyperplasia: A Cost-Effectiveness Analysis

Wednesday, March 8, 2023

3:54 PM – 4:03 PM

Location: Phoenix Convention Center, 226ABC

Presenting Author(s)

Xiao Wu, MD (she/her/hers)

Resident Physician
University of California, San Francisco

Disclosure(s): No financial relationships to disclose

Author/Co-author(s)

Alice L. Zhou, MD

Resident Physician
University of California, San Francisco
MH

Michael B. Heller, MD

Health System Clinician
University of California, San Francisco
RK

Ryan Kohlbrenner, MD

Assistant Professor
University of California, San Francisco

Disclosure(s):

Xiao Wu, MD: No financial relationships to disclose

Purpose:

To compare the cost-effectiveness of prostate artery embolization (PAE) and minimally invasive urologic procedures, including Urolift, Rezum, and Aquablation for the treatment of benign prostate hypertrophy (BPH).

Materials and Methods:

A cost-effectiveness analysis with Markov modeling was performed, comparing PAE Urolift, Rezum, and Aquablation with a time horizon of 4 years, for medically refractory BPH. The model incorporated possibilities of procedural complications and recurrent symptoms necessitating retreatment. Probabilities of these events were extracted from the literature, including randomized controlled trials and large-cohort studies with long-term follow-up. Costs were based on Medicare reimbursements and published cost-analyses, adjusted to 2022. Outcomes were measured by quality-adjusted life year (QALY), incorporating both life quality and expectancy. Statistical analyses included base case calculation, probabilistic, and deterministic sensitivity analyses.

Results:

In base case calculation, outcomes after the 4 strategies were comparable (Table 1). The difference between PAE and Rezum outcomes was 0.026 QALY, equivalent to 9.5 days of life in perfect health. Among the 4 modalities, PAE had the lowest cost at $2,613 and Aquablation the highest $9,400, making PAE the dominant strategy. Probabilistic sensitivity analysis showed PAE remained as the more cost-effective strategy in 100%, 99.99%, and 78.15% of the simulations when pair-wised compared with Urolift, Aquablation, and Rezum. When varying risk of retreatment, Rezum would replace PAE to be the more cost-effective strategy if the risk of retreatment after PAE was higher than 16.2% per year (base case: 3.8%). PAE remained the more cost-effective strategy when varying the risk of retreatment in other strategies from 0 to 30%. PAE was cost-effective when its procedural cost were lower than $5,443 (base case: $2,245). Urolift and Aquablation became the most cost-effective strategy when their procedural cost were lower than $1,109 and $1,925 respectively.

Conclusion:

PAE is a more cost-effective strategy to treat medically refractory BPH compared to minimally invasive urologic procedures including Urolift, Rezum, and Aquablation, resulting in comparable health benefits at a lower cost.