Greenlight laser vaporization versus transurethral resection of the prostate for the treatment of benign prostatic obstruction: evidence from randomized controlled studies

Elhilali, Mostafa; Elkoushy, Mohamed A.

doi:10.21037/tau.2016.03.09

Cited by 6 publications

(2 citation statements)

References 21 publications

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“… 69 – 71 PVP serves as an alternative to TURP as TURP may be associated with perioperative morbidities directly related to prostate volume and surgically high-risk patients with associated comorbidity, including pacemakers, and anticoagulant and platelet anti-aggregate medications. 72 , 73 TURP and Greenlight PVP remain the most costly alternatives today and typically are reserved for treatment of moderate-to-severe LUTS or larger prostates. While they among the most cost-effective treatments for relief of symptoms as shown in Figure 4 , the rates of AEs, including incontinence, UTI, ED, AUR, and bladder neck contracture, for these surgical procedures are significant, again contributing to more discomfort for the patients and costs to payers.…”

Section: Discussionmentioning

confidence: 99%

Cost-effectiveness analysis of six therapies for the treatment of lower urinary tract symptoms due to benign prostatic hyperplasia

Ulchaker¹,

Martinson

2017

CEOR

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ObjectiveTo conduct a cost-effectiveness analysis from payers’ perspectives of six treatments for lower urinary tract symptoms (LUTS) associated with benign prostatic hyperplasia (BPH) and to examine positioning of these modalities in the marketplace for the best use of health care funds and quality-of-life benefits for patients.MethodsThe economic analysis was conducted with a Markov model to compare combination prescription drug therapy (ComboRx), minimally invasive therapies (MITs) including convective radiofrequency (RF) water vapor thermal therapy (Rezūm®), conductive RF thermal therapy (Prostiva®), and prostatic urethral lift (UroLift®), and invasive surgical procedures including photovaporization of the prostate (Greenlight® PVP) and transurethral resection of the prostate (TURP). Effects assessed with International Prostate Symptom Score, adverse events, and re-treatment rates were estimated from medical literature; treatments effects were modeled using a common baseline score. Starting with each therapy, patients’ transitions to more intensive therapies when symptoms returned were simulated in 6-month cycles over 2 years. Incremental cost-effectiveness ratios (ICERs) were calculated for pairs of treatments; uncertainty in ICERs was estimated with probabilistic sensitivity analyses.ResultsComboRx was least effective and provided one-third of the symptom relief achieved with MITs. UroLift was similar in effectiveness to Prostiva and Rezūm but costs more than twice as much. The cheaper MITs were ~$900 more expensive than the cost of ComboRx generic drugs over 2 years. TURP and PVP provided slightly greater relief of LUTS than MITs at approximately twice the cost over 2 years; typically, they are reserved for treatment of more severe LUTS.ConclusionThe analysis evaluated the costs and symptom relief of six treatment options in the continuum of care from a common baseline of LUTS severity. Identification of treatments for LUTS/BPH that demonstrate cost-effectiveness and provide appreciable symptom relief is paramount as reimbursement for patient care moves from volume-based services to value-based services.

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Section: Discussionmentioning

confidence: 99%

Cost-effectiveness analysis of six therapies for the treatment of lower urinary tract symptoms due to benign prostatic hyperplasia

Ulchaker¹,

Martinson

2017

CEOR

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“…While the GOLIATH trial excluded patients with prostate volumes >80g, 6 a recent randomized controlled trial (RCT) randomized men with prostate sizes of 80-150g (average 105g) to PVP versus transurethral resection of the prostate (TURP) versus holmium laser enucleation of the prostate (HoLEP) and found similar efficacy with regards to IPSS; however, PVP had a retreatment rate of 27% at 3 years of follow-up. 7-9 Additionally, the need for a blood transfusion was lower for PVP compared to TURP; as such, PVP may be preferential for medically complicated patients on anticoagulation.…”

Section: Guideline Statement Updatesmentioning

confidence: 99%

Management of Lower Urinary Tract Symptoms Attributed to Benign Prostatic Hyperplasia (BPH): AUA Guideline Amendment 2023

Sandhu,

Bixler,

Dahm

et al. 2024

Journal of Urology

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Purpose:The purpose of this American Urological Association (AUA) Guideline amendment is to provide a useful reference on the effective evidence-based management of male lower urinary tract symptoms secondary/attributed to BPH (LUTS/BPH).Materials and Methods:The Minnesota Evidence Review Team searched Ovid MEDLINE, the Cochrane Library, and the Agency for Healthcare Research and Quality (AHRQ) database to identify studies relevant to the management of BPH. The guideline was updated in 2023 to capture eligible literature published between September 2020 and October 2022. When sufficient evidence existed, the body of evidence was assigned a strength rating of A (high), B (moderate), or C (low) for support of Strong, Moderate, or Conditional Recommendations. In the absence of sufficient evidence, additional information is provided as Clinical Principles and Expert Opinions.Results:The BPH amendment resulted in changes to statements/supporting text on combination therapy, photoselective vaporization of the prostate (PVP), water vapor thermal therapy (WVTT), laser enucleation, and prostate artery embolization (PAE). A new statement on temporary implanted prostatic devices (TIPD) was added. In addition, statements on transurethral needle ablation (TUNA) and transurethral microwave thermotherapy (TUMT) were removed and information regarding these legacy technologies was added to the background section. References and the accompanying treatment algorithms were updated to align with the updated text.Conclusion:This guideline seeks to improve clinicians’ ability to evaluate and treat patients with BPH/LUTS based on currently available evidence. Future studies will be essential to further support these statements to improve patient care.

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Cost-effectiveness of Medical Versus Surgical Therapy for BPH

Shabataev

Allahwala

2019

Curr Bladder Dysfunct Rep

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Greenlight laser vaporization versus transurethral resection of the prostate for the treatment of benign prostatic obstruction: evidence from randomized controlled studies

Cited by 6 publications

References 21 publications

Cost-effectiveness analysis of six therapies for the treatment of lower urinary tract symptoms due to benign prostatic hyperplasia

Cost-effectiveness analysis of six therapies for the treatment of lower urinary tract symptoms due to benign prostatic hyperplasia

Management of Lower Urinary Tract Symptoms Attributed to Benign Prostatic Hyperplasia (BPH): AUA Guideline Amendment 2023

Cost-effectiveness of Medical Versus Surgical Therapy for BPH

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