Prostate artery embolization (PAE) is more cost-effective than transurethral resection of the prostate (TURP), the gold standard for the management of patients with benign prostate hyperplasia (BPH) at one-year follow-up. However, embolization exhibits a higher reintervention rate, which may reduce the cost-effectiveness in subsequent years following intervention.
There were the concluding findings of a retrospective cost-utility analysis from a UK National Health Service (NHS) perspective, published in October 2021 in BMJ Surgery Interventions & Health Technologies, Sachin Modi, University Hospital Southampton NHS Foundation Trust, Southampton, UK (senior author) and colleagues.
The prevalence of BPH increases with age, which, combined with an ageing population in the UK, will create a financial burden on the NHS. With PAE offering a minimally invasive alternative, Modi and colleagues set out to investigate the cost-effectiveness of PAE vs. TURP, in the management of BPH after one-year follow-up. This comparison study, therefore, collected patient data from the UK Register of Prostate Embolization (UK-ROPE) study at one, three, six and 12 months. UK-ROPE holds data on patients treated with embolization or surgical interventions from across 20 U.K centres, and was funded by the UK National Institute for Health and Care Excellence (NICE). In the UK-ROPE study, male patients received either embolization (PAE) (n=133), surgery (TURP) (n=31), open prostatectomy or holmium laser enucleation of the prostate (HoLEP) between July 2014 and January 2016. Patient outcome data was collected on the International Prostate Symptom Score (IPSS), quality of life (QoL) and International Index of Erectile Function (IIEF).
Within the cost analysis, effectiveness was measured as quality-adjusted life years (QALYs) and the costs for both embolization and surgery were taken from University Hospital Southampton data, using 2016 as a reference year. An incremental cost-effectiveness ratio (ICER) was then derived from cost, IPSS values and QALY values associated with both interventions at 12 months.
The original UK-ROPE study outcomes showed no significant differences in patient baseline IIEF, prostate volume or maximum urinary flow rate, however, and it demonstrated that embolization showed a significant statistically improvement in IPSS and QoL post-procedure. However, the improvement in IPSS following surgery was greater.
Within the embolization group, the QALY value was 0.96 (SD=0.03), compared to a surgery QALY score of 0.98 (SD=0.03). The average cost per patient of embolization and surgery was £2,000 and £3,028, respectively. Therefore, the ICER was £64,798.10 saved per QALY lost, making embolization more cost-effective. Within the patient cohort, 36% of those who received embolization reported complications at 12 months, with 84% of surgery patients also reporting complications in the same timeframe.
In conclusion, embolization was deemed to be a more cost-effective intervention in the management of BPH compared to TURP. Shorter patient stays and the lack of necessity for an operating theatre/anaesthesia were major contributing factors to this, however, due to a higher reintervention rate in the embolization group, the authors suggest that this benefit may not be maintained in subsequent years and longer term comparison studies are required to fully evaluate this.
