To evaluate the financial impact of surgical modalities for benign prostatic hyperplasia (BPH) from the perspective of an NHS Trust.
A retrospective analysis of patients undergoing Aquablation, Holmium Laser Enucleation of the Prostate (HoLEP) and Transurethral Resection of the Prostate (TURP) was conducted at a single NHS teaching hospital between January 2023 and June 2025. Financial data was extracted from the patient-level information and costing system, including clinical income based on Healthcare Resource Group tariffs, direct and indirect costs, and overheads. Primary outcomes were median episode clinical income, total costs, and net surplus/deficit.
436 procedures were analysed (140 Aquablation, 160 HoLEP, 136 TURP). Mean operative time was shortest for Aquablation (61.8 ± 27.0 min), while HoLEP had the shortest length of stay (0.34 ± 1.18 days). Aquablation was the only procedure to yield a median net surplus (+£1,859, IQR +785 to +2,736), whereas both HoLEP (-£157, IQR -679 to +189) and TURP (-£852, IQR -1,716 to +84) resulted in median deficits (p < 0.001). Aquablation's financial advantage was driven by its robotic-assisted classification, attracting a higher median clinical income (£7,659) than HoLEP (£3,038) and TURP (£2,997) (p < 0.001). Surplus-generating episodes were more frequent for Aquablation (83.6%) than HoLEP (28.1%) or TURP (22.1%) (p < 0.001). Major individual losses were driven by complications and prolonged admissions across all cohorts.
This single-centre retrospective study focused on short-term hospital-level costs. It did not account for initial capital expenditure, long-term clinical outcomes, or Quality-Adjusted Life-Years.
Under the current NHS Payment Scheme, Aquablation is the only financially sustainable surgical modality for the provider among those analysed. Its higher robotic-assisted tariff compensates for greater consumable costs. National tariff reviews may be warranted to ensure reimbursement reflects the true resource intensity of all surgical interventions. Establishing broader NHS cost-effectiveness will require long-term evaluation of clinical outcomes and retreatment rates.
Journal of medical economics. 2026 Jul 01 [Epub]
Shiv Sarna, Sachinka Ranasinghe, Ranil Johann Boaz, Mark Rochester
Department of Urology, Norfolk and Norwich University Hospital, Norwich, UK.