Prostate Artery Embolization and Transurethral Resection of the Prostate for Benign Prostatic Hyperplasia: A Cost-Effectiveness Analysis.

To compare the cost-effectiveness of prostate artery embolization (PAE) and transurethral resection of the prostate (TURP) for the treatment of medically refractory benign prostatic hyperplasia (BPH).

A cost-effectiveness analysis with Markov modeling was performed, comparing the clinical course following PAE and TURP for 3 years. Probabilities were obtained from the available literature, and costs were based on Medicare reimbursements and published cost-analyses. Outcomes were measured by quality-adjusted life year (QALY). Statistical analyses included base case calculation, probabilistic, and deterministic sensitivity analyses to assess the robustness of the conclusion under different clinical scenarios.

Base case showed comparable outcomes (PAE: 2.845 QALY, TURP: 2.854 QALY) with a cost difference of $3,104 (PAE: $2,934, TURP: $6,038). The incremental cost-effectiveness ratio was $360,249/QALY. PAE was dominant in 23.2% and more cost-effective in 48.4% of the probabilistic sensitivity analysis simulations. PAE was better if its recurrence risk was <20.4% per year, and even when the TURP recurrence risk was assumed to be 0%. TURP would be more cost-effective when its procedural cost was <$3,367, and the PAE procedural cost >$4,409. PAE remained cost-effective varying risks and costs of minor and major short- or long-term complications of both procedures. TURP would be the better strategy if the utility of BPH recurrence was < 0.85 QALY (0.94 QALY).

PAE is a cost-effective strategy to treat medically refractory BPH, resulting in comparable health benefits at a lower cost compared to TURP even accounting for extreme alterations in complications, costs, and recurrence rates.

Journal of vascular and interventional radiology : JVIR. 2022 Aug 11 [Epub ahead of print]

Xiao Wu, Alice Zhou, Michael Heller, Ryan Kohlbrenner

Department of Radiology and Biomedical Imaging, University of California, San Francisco., Department of Radiology and Biomedical Imaging, University of California, San Francisco. Electronic address: .