Cost-effectiveness of Medical Versus Surgical Therapy for BPH

  • Valentin Shabataev
  • Ashraf Allahwala
  • Dean S. EltermanEmail author
BPH-Related Voiding Dysfunction (R Lee, Section Editor)
Part of the following topical collections:
  1. Topical Collection on BPH-Related Voiding Dysfunction
  2. Topical Collection on BPH-Related Voiding Dysfunction


Purpose of Review

Benign prostatic enlargement and obstruction may result in lower urinary tract symptom (LUTS) and have a negative impact on a patient’s quality of life. The purpose of this review is to analyze different management options, specifically evaluating the cost-effectiveness of medical versus surgical therapy for BPH.

Recent Findings

We performed a detailed review comparing various studies regarding the cost-effectiveness of different management options that were conducted in the last 5 years. When comparing monotherapy with combination therapy in medical treatments, the latter was found to be more cost-effective. Branded combined medical therapies were found to be much more expensive than generic medical therapies but demonstrated the same therapeutic outcome. When looking at operative options, specifically among the transurethral surgeries, there are more invasive options, including mono/bipolar transurethral resection of prostate (TURP) and laser vaporization and there are less invasive modalities (MIST) such as Urolift, Rezūm, transurethral microwave thermotherapy (TUMT), and transurethral needle ablation (TUNA). The findings demonstrated the cost of the more invasive options depended on whether the procedure was conducted as an inpatient or outpatient, with inpatient surgeries being the more expensive. In this context, GreenLight PVP, being performed as an outpatient procedure, was less expensive than TURP. Both of them provided the best relief in BPH symptoms but were found to have a higher incidence of side effects. Accordingly, it has been estimated the cost of MIST to be not only cheaper (except Urolift) than invasive transurethral options, but noted to have fewer side effects, especially in terms of ejaculatory dysfunction.


Although combination generic medical therapy has been shown to be the least costly option, when invasive surgical management, such as TURP or GreenLight PVP as the most expensive, cost by itself is not the only metric to assess a BPH therapy. The more valuable criterion, such as cost-effectiveness, must be examined. In this light, MIST and especially Rezūm do appear to have a cost-effectiveness advantage over the other procedures due to its lower price and fewer side effects, while providing similar clinical efficacy.


Benign prostatic hyperplasia Benign prostatic enlargement BPH Cost-effectiveness Cost utility Comparison BPH treatments 


Compliance with Ethical Standards

Conflict of Interest

Dr. Dean Elterman declares consultancy and scientific advisory board with Boston Scientific. Dr. Valentin Shabataev and Dr. Ashraf Allahwala declare that they have no conflict of interest.

Human and Animal Rights and Informed Consent

This article does not contain any studies with human or animal subjects performed by any of the authors.


Papers of particular interest, published recently, have been highlighted as: • Of importance •• Of major importance

  1. 1.
    Vuichoud C, Loughlin KR. Benign prostatic hyperplasia: epidemiology, economics and evaluation. Can J Urol. 2015;22:1–6.Google Scholar
  2. 2.
    Lee SWH, Chan EMC, Lai YK. The global burden of lower urinary tract symptoms suggestive of benign prostatic hyperplasia: a systematic review and meta-analysis. Sci Rep. 2017;7:1–10.CrossRefGoogle Scholar
  3. 3.
    Ismaila A, Walker A, Sayani A, Laroche B, Nickel JC, Posnett J, et al. Cost-effectiveness of dutasteride-tamsulosin combination therapy for the treatment of symptomatic benign prostatic hyperplasia: a Canadian model based on the CombAT trial (provisional abstract). Can Urol Assoc J. 2013;7:E393–e401.CrossRefGoogle Scholar
  4. 4.
    • Gill BC, Ulchaker JC, Gill BC (2018) Costs of managing benign prostatic hyperplasia in the office and operating room. This study demonstrates the cost difference between out- and inpatient nature of procedures.Google Scholar
  5. 5.
    • Ulchaker JC, Martinson M. Cost-effectiveness analysis of six therapies for the treatment of lower urinary tract symptoms due to benign prostatic hyperplasia. Clin Outcomes Res. 2017;10:29–43 The study performs a cost analysis of different treatment options, including distinction between brand and generic medication.Google Scholar
  6. 6.
    McNicholas T. Benign prostatic hyperplasia and new treatment options – a critical appraisal of the UroLift system. Med Devices Evid Res. 2016:115.Google Scholar
  7. 7.
    Cindolo L, Pirozzi L, Fanizza C, Romero M, Tubaro A, Autorino R, et al. Drug adherence and clinical outcomes for patients under pharmacological therapy for lower urinary tract symptoms related to benign prostatic hyperplasia: population-based cohort study. Eur Urol. 2015;68:418–25.CrossRefGoogle Scholar
  8. 8.
    Foster HE, Barry MJ, Dahm P, Gandhi MC, Kaplan SA, Kohler TS, et al. Surgical management of lower urinary tract symptoms attributed to benign prostatic hyperplasia: AUA guideline. J Urol. 2018;200:612–9.CrossRefGoogle Scholar
  9. 9.
    Mamoulakis C, Sofras F, de la Rosette J, Omar MI, Lam TB, N’Dow JM, et al. Bipolar versus monopolar transurethral resection of the prostate for lower urinary tract symptoms secondary to benign prostatic obstruction. Cochrane Database Syst Rev. 2014.
  10. 10.
    Elhilali MM, Elkoushy MA. Greenlight laser vaporization versus transurethral resection of the prostate for the treatment of benign prostatic obstruction: evidence from randomized controlled studies. Transl Androl Urol. 2016;5:388–92.CrossRefGoogle Scholar
  11. 11.
    Benejam-Gual JM, Sanz-Granda A, García-Miralles Grávalos R, Severa-Ruíz De Velasco A, Pons-Viver J. Cost-effectiveness analysis at 2 years of surgical treatment of benign prostatic hyperplasia by photoselective vaporization of the prostate with GreenLight-Photo vaporization 120 W versus transurethral resection of the prostate Abstract. Actas Urol Esp. 2014;38:238–43.CrossRefGoogle Scholar
  12. 12.
    Whitty JA, Crosland P, Hewson K, Narula R, Nathan TR, Campbell PA, et al. A cost-minimisation analysis comparing photoselective vaporisation (PVP) and transurethral resection of the prostate (TURP) for the management of symptomatic benign prostatic hyperplasia (BPH) in Queensland, Australia. BJU Int. 2014;113:21–8.CrossRefGoogle Scholar
  13. 13.
    Whelan JP, Bowen JM, Burke N, Woods EA, McIssac GP, Hopkins RB, et al. A prospective trial of GreenLight PVP (HPS120) versus transurethral resection of the prostate in the treatment of lower urinary tract symptoms in Ontario, Canada. J Can Urol Assoc. 2013;7:335–41.CrossRefGoogle Scholar
  14. 14.
    •• Masucci L, Erman A, Krahn M, Elterman D. Cost analysis of Greenlight photoselective vaporization of the prostate compared to transurethral resection of the prostate for benign prostatic hyperplasia. Can Urol Assoc J. 2018; This study demonstrated a cost savings with GreenLight PVP over traditional TURP, mostly due to outpatient nature, as well as lower readmission rate with GreenLight PVP.Google Scholar
  15. 15.
    Teng J, Zhang D, Li Y, Yin L, Wang K, Cui X, et al. Photoselective vaporization with the green light laser vs transurethral resection of the prostate for treating benign prostate hyperplasia: a systematic review and meta-analysis. BJU Int. 2013;111:312–23.CrossRefGoogle Scholar
  16. 16.
    •• Erman A, Masucci L, Krahn MD, Elterman DS. Pharmacotherapy vs surgery as initial therapy for patients with moderate-to-severe benign prostate hyperplasia: a cost-effectiveness analysis. BJU Int. 2018;0–3 This study evaluated the cost-effectiveness of different common treatment combinations of BPH by probabilistic analysis.Google Scholar
  17. 17.
    Roehrborn CG, Barkin J, Gange SN, et al. Five year results of the prospective randomized controlled prostatic urethral L.I.F.T. study. Can J Urol. 2017;24:8802–13.Google Scholar
  18. 18.
    McVary KT, Roehrborn CG. Three-year outcomes of the prospective, randomized controlled Rezūm System study: convective radiofrequency thermal therapy for treatment of lower urinary tract symptoms due to benign prostatic hyperplasia. Urology. 2018;111:1–9.CrossRefGoogle Scholar

Copyright information

© Springer Science+Business Media, LLC, part of Springer Nature 2019

Authors and Affiliations

  • Valentin Shabataev
    • 1
  • Ashraf Allahwala
    • 1
  • Dean S. Elterman
    • 1
    • 2
    Email author
  1. 1.Division of Urology, Department of SurgeryUniversity of TorontoTorontoCanada
  2. 2.Toronto Western HospitalTorontoCanada

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