World Journal of Urology

, Volume 37, Issue 5, pp 873–878 | Cite as

Medical therapy versus transurethral resection of the prostate (TURP) for the treatment of symptomatic benign prostatic enlargement (BPE): a cost minimisation analysis

  • Niall F. DavisEmail author
  • G. S. Jack
  • W. P. Witjes
  • A. Bjartell
  • C. Caris
  • A. Patel
  • A. de la Taille
  • N. Lawrentschuk
  • D. M. Bolton
  • A. Tubaro
Original Article



A cost minimisation analysis compares the costs of different interventions’ to ascertain the least expensive over time. We compared different prostate targeted drug treatments with TURP to identify the optimal cost saving duration of a medical therapy for symptomatic benign prostatic enlargement (BPE).


The Evolution registry is a prospective, multicentre registry, conducted by the European Association of Urology Research Foundation (EAUrf) for 24 months in 5 European countries. Evolution was designed to register the management of symptomatic BPE in clinical practice settings in 5 European countries. Direct cost evaluation associated with prostate targeted medical therapies and TURP was also recorded and analysed.


In total, 1838 men were enrolled with 1246 evaluable at 24 months. Medical therapies were more cost saving than TURP for treatment durations ranging from 2.9 to 70.4 years. Cost saving depended on both medication class and individual country assessed. Daily tamsulosin monotherapy was more cost saving than TURP for ≤ 13.9 years in Germany compared to ≤ 32.7 years in Italy. Daily finasteride monotherapy was more cost saving for ≤ 5.9 years in France compared to ≤ 36.9 years in Spain. Combination therapy was more cost saving for ≤ 5.9 years for Italian patients versus ≤ 13.8 years in Germany.


BPE medical management was more cost saving than TURP for different specific treatment durations. Information from this study will allow clinicians to convey medical and surgical costs over time, to both patients and payors alike, when considering BPE treatment.


Benign prostatic enlargement BPE Benign prostatic hyperplasia BPH Cost minimisation analysis 



Benign prostatic enlargement




Transurethral resection of the prostate


Author contributions

ND: Data collection, Data analysis, Manuscript writing; GJ: Data analysis, Manuscript writing; WW: Data collection, Manuscript editing; AB: Project development, Manuscript editing; CC: Data collection, Manuscript editing; AP: Data collection, Manuscript editing; AT: Data collection, Manuscript editing; DB: Project development, Manuscript editing; AT: Data analysis, Project development, Manuscript editing.


The Evolution registry was supported by a restricted Grant from GlaxoSmithKline© (GSK).

Compliance with ethical standards

Conflict of interest

The authors declare that they have no conflicts of interest.

Statement of human rights

All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standard.

Informed consent

Informed consent was obtained from all individual participants included in the study.


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Copyright information

© Springer-Verlag GmbH Germany, part of Springer Nature 2018

Authors and Affiliations

  • Niall F. Davis
    • 1
    Email author
  • G. S. Jack
    • 1
  • W. P. Witjes
    • 2
  • A. Bjartell
    • 2
    • 3
  • C. Caris
    • 2
  • A. Patel
    • 4
  • A. de la Taille
    • 5
  • N. Lawrentschuk
    • 1
  • D. M. Bolton
    • 1
  • A. Tubaro
    • 6
  1. 1.Department of UrologyThe Austin HospitalMelbourneAustralia
  2. 2.EAU Research FoundationArnhemThe Netherlands
  3. 3.Department of UrologyLund University, Skane HospitalMalmöSweden
  4. 4.Department of UrologySpire London East HospitalIlfordUK
  5. 5.Department of UrologyAssistance Publique des Hopitaux de ParisCréteilFrance
  6. 6.Department of UrologySant’Andrea Hospital, Sapienza University of RomeRomeItaly

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