Skip to main navigation menu Skip to main content Skip to site footer
##common.pageHeaderLogo.altText##

Original article

Vol. 152 No. 1112 (2022)

In-hospital cost analysis of aquablation compared with transurethral resection of the prostate in the treatment of benign prostatic enlargement

  • Gautier Müllhaupt
  • Pavel Lyatoshinsky
  • Anne Neuenschwander
  • Sabine Güsewell
  • Hans-Peter Schmid
  • Dominik Abt
DOI
https://doi.org/10.4414/SMW.2022.w30136
Cite this as:
Swiss Med Wkly. 2022;152:w30136
Published
22.03.2022

Summary

PURPOSE: To compare in-hospital treatment costs of aquablation and transurethral resection of the prostate (TURP) in the treatment of benign prostatic enlargement.

PATIENTS AND METHODS: Patient data and procedural details were derived from a prospective database. In-hospital costs were calculated using detailed expenditure reports provided by the hospital accounts department. Total costs including those arising from surgical procedures, consumables, personnel and accommodation were analysed for 24 consecutive patients undergoing aquablation and compared with 24 patients undergoing TURP during the same period. Mean total costs and mean costs for individual expense items were compared between treatment groups with t-tests.

RESULTS: Mean total costs per patient (± standard deviation) were higher for aquablation at EUR 10,994 ± 2478 than for TURP at EUR 7445 ± 2354. The mean difference of EUR 3549 was statistically significant (p <0.001). Although the mean procedural costs were significantly higher for aquablation (mean difference EUR 3032; p <0.001), costs apart from the procedure were also lower for TURP, but the mean difference of EUR 1627 was not significant (p <0.327). Medical supplies were mainly responsible (mean difference EUR 2057; p <0.001) for the difference in procedural costs.

CONCLUSIONS: In-hospital costs are significantly higher for aquablation than for TURP, mainly due to higher costs of medical supplies for the procedure. This difference should be taken into consideration, at least in patients for whom the different side effect profiles of both treatments are irrelevant.

References

  1. Berry SJ, Coffey DS, Walsh PC, Ewing LL. The development of human benign prostatic hyperplasia with age. J Urol. 1984 Sep;132(3):474–9. https://doi.org/10.1016/s0022-5347(17)49698-4 https://doi.org/10.1016/S0022-5347(17)49698-4
  2. Taub DA, Wei JT. The economics of benign prostatic hyperplasia and lower urinary tract symptoms in the United States. Curr Urol Rep. 2006 Jul;7(4):272–81. https://doi.org/10.1007/s11934-996-0006-0
  3. van Exel NJ, Koopmanschap MA, McDonnell J, Chapple CR, Berges R, Rutten FF ; TRIUMPH Pan-European Expert Panel. Medical consumption and costs during a one-year follow-up of patients with LUTS suggestive of BPH in six european countries: report of the TRIUMPH study. Eur Urol. 2006 Jan;49(1):92–102. https://doi.org/10.1016/j.eururo.2005.09.016
  4. Gilling P, Reuther R, Kahokehr A, Fraundorfer M. Aquablation - image-guided robot-assisted waterjet ablation of the prostate: initial clinical experience. BJU Int. 2016 Jun;117(6):923–9. https://doi.org/10.1111/bju.13358
  5. Faber K, de Abreu AL, Ramos P, Aljuri N, Mantri S, Gill I, et al. Image-guided robot-assisted prostate ablation using water jet-hydrodissection: initial study of a novel technology for benign prostatic hyperplasia. J Endourol. 2015 Jan;29(1):63–9. https://doi.org/10.1089/end.2014.0304
  6. Gilling P, Anderson P, Tan A. Aquablation of the Prostate for Symptomatic Benign Prostatic Hyperplasia: 1-Year Results. J Urol. 2017 Jun;197(6):1565–72. https://doi.org/10.1016/j.juro.2017.01.056
  7. Yassaie O, Silverman JA, Gilling PJ. Aquablation of the Prostate for Symptomatic Benign Prostatic Hyperplasia: early Results. Curr Urol Rep. 2017 Oct;18(12):91. https://doi.org/10.1007/s11934-017-0743-2
  8. Bach T, Giannakis I, Bachmann A, Fiori C, Gomez-Sancha F, Herrmann TR, et al. Aquablation of the prostate: single-center results of a non-selected, consecutive patient cohort. World J Urol. 2019 Jul;37(7):1369–75. https://doi.org/10.1007/s00345-018-2509-y
  9. Desai MM, Singh A, Abhishek S, Laddha A, Pandya H, Ashrafi AN, et al. Aquablation therapy for symptomatic benign prostatic hyperplasia: a single-centre experience in 47 patients. BJU Int. 2018 Jun;121(6):945–51. https://doi.org/10.1111/bju.14126
  10. Gilling P, Barber N, Bidair M, Anderson P, Sutton M, Aho T, et al. WATER: A Double-Blind, Randomized, Controlled Trial of Aquablation® vs Transurethral Resection of the Prostate in Benign Prostatic Hyperplasia. J Urol. 2018 May;199(5):1252–61. https://doi.org/10.1016/j.juro.2017.12.065
  11. Kasivisvanathan V, Hussain M. Aquablation versus transurethral resection of the prostate: 1 year United States - cohort outcomes. Can J Urol. 2018 Jun;25(3):9317–22.
  12. Gilling P, Barber N, Bidair M, Anderson P, Sutton M, Aho T, et al. Two-Year Outcomes After Aquablation Compared to TURP: Efficacy and Ejaculatory Improvements Sustained. Adv Ther. 2019 Jun;36(6):1326–36. https://doi.org/10.1007/s12325-019-00952-3
  13. Gilling P, Barber N, Bidair M, Anderson P, Sutton M, Aho T, et al. Three-year outcomes after Aquablation therapy compared to TURP: results from a blinded randomized trial. Can J Urol. 2020 Feb;27(1):10072–9.
  14. World Medical Association. Declaration of Helsinki - ethical principles for medical research involving human subjects [Internet]. 1964 [cited 25 August 2018]. Available from: https://www.wma.net/en/
  15. International conference on harmonisation: Good clinical practice guideline [Internet]. [cited 25 August 2018]. Available from: www.compendium.ch. http://www.ich.org/products/guidelines/efficacy/article/efficacyguidelines
  16. MacRae C, Gilling P. How I do it: aquablation of the prostate using the AQUABEAM system. Can J Urol. 2016 Dec;23(6):8590–3.
  17. Milam DF. Transurethral resection of the prostate. In: Smith JA, Howards SS, McGuire EJ, Preminger GM, eds. Hinman’s atlas of urologic surgery. Elsevier, 2012. doi:https://doi.org/10.1016/B978-1-4160-4210- 5.00080-3 https://doi.org/10.1016/B978-1-4160-4210-5.00080-3
  18. Müllhaupt G, Enzler-Tschudy A, Horg K, Bubendorf L, Pratsinis M, Schmid HP, et al. Informative value of histological assessment of tissue acquired during aquablation of the prostate. World J Urol. 2021 Jun;39(6):2043–7. https://doi.org/10.1007/s00345-020-03426-2
  19. Bach T, Gilling P, El Hajj A, Anderson P, Barber N. First Multi-Center All-Comers Study for the Aquablation Procedure. J Clin Med. 2020 Feb;9(2):E603. https://doi.org/10.3390/jcm9020603
  20. Roehrborn CG, Teplitsky S, Das AK. Aquablation of the prostate: a review and update. Can J Urol. 2019 Aug;26(4 Suppl 1):20–4.
  21. Fayad AS, Sheikh MG, Zakaria T, Elfottoh HA, Alsergany R. Holmium laser enucleation versus bipolar resection of the prostate: a prospective randomized study. Which to choose? J Endourol. 2011 Aug;25(8):1347–52. https://doi.org/10.1089/end.2011.0059
  22. Mathieu R, Lebdai S, Cornu JN, Benchikh A, Azzouzi AR, Delongchamps NB, et al. Perioperative and economic analysis of surgical treatments for benign prostatic hyperplasia: A study of the French committee on LUT. Prog Urol. 2017 May;27(6):362–8. https://doi.org/10.1016/j.purol.2017.03.010
  23. Müllhaupt G, Hechelhammer L, Engeler DS, Güsewell S, Betschart P, Zumstein V, et al. In-hospital cost analysis of prostatic artery embolization compared with transurethral resection of the prostate: post hoc analysis of a randomized controlled trial. BJU Int. 2019 Jun;123(6):1055–60. https://doi.org/10.1111/bju.14660

Most read articles by the same author(s)