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The cost-effectiveness of transurethral resection of the prostate vs thulium laser transurethral vaporesection of the prostate in the UNBLOCS randomised controlled trial for benign prostatic obstruction

Lookup NU author(s): Dr Tobias Page



This work is licensed under a Creative Commons Attribution 4.0 International License (CC BY 4.0).


© 2020 The Authors BJU International published by John Wiley & Sons Ltd on behalf of BJU International. Objective: To determine the cost-effectiveness of the current ‘gold standard’ operation of transurethral resection of the prostate (TURP) compared to the new laser technique of thulium laser transurethral vaporesection of the prostate (ThuVARP) in men with benign prostatic obstruction (BPO) within the UK National Health Service (NHS). Patients and Methods: The trial was conducted across seven UK centres (four university teaching hospitals and three district general hospitals). A total of 410 men aged ≥18 years presenting with either bothersome lower urinary tract symptoms (LUTS) or urinary retention secondary to BPO, and suitable for surgery, were randomised (whilst under anaesthetic) 1:1 to receive the TURP or ThuVARP procedure. Resource use in relation to the operation, initial inpatient stay, and subsequent use of NHS services was collected for 12 months from randomisation (equivalent to primary effectiveness outcome) using hospital records and patient questionnaires. Resources were valued using UK reference costs. Quality adjusted life years (QALYs) were calculated from the EuroQoL five Dimensions five Levels (EQ-5D-5L) questionnaire completed at baseline, 3- and 12-months. Total adjusted mean costs, QALYs and incremental Net Monetary Benefit statistics were calculated: cost-effectiveness acceptability curves and sensitivity analyses addressed uncertainty. Results: The total adjusted mean secondary care cost over the 12 months in the TURP arm (£4244) was £9 (95% CI –£376, £359) lower than the ThuVARP arm (£4253). The ThuVARP operation took on average 21 min longer than TURP. The adjusted mean difference of QALYs (0.01 favouring TURP, 95% CI −0.01, 0.04) was similar between the arms. There is a 76% probability that TURP is the cost-effective option compared with ThuVARP at the £20 000 per QALY willingness to pay threshold used by National Institute for Health and Care Excellence (NICE). Conclusion: One of the anticipated benefits of the laser surgery, reduced length of hospital stay with an associated reduction in cost, did not materialise within the study. The longer duration of the ThuVARP procedure is important to consider, both from a patient perspective in terms of increased time under anaesthetic, and from a service delivery perspective. TURP remains a highly cost-effective treatment for men with BPO.

Publication metadata

Author(s): Noble SM, Ahern AM, Worthington J, Hashim H, Taylor H, Young GJ, Brookes S, Abrams P, Johnson L, Khan R, Page T, Swami KS, Lane JA

Publication type: Article

Publication status: Published

Journal: BJU International

Year: 2020

Volume: 126

Issue: 5

Pages: 595-603

Print publication date: 01/11/2020

Online publication date: 17/06/2020

Acceptance date: 03/06/2020

Date deposited: 02/08/2021

ISSN (print): 1464-4096

ISSN (electronic): 1464-410X

Publisher: John Wiley & Sons Ltd


DOI: 10.1111/bju.15138

PubMed id: 32558178


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