Expanding treatments for lower urinary tract symptoms, secondary to benign prostatic enlargement. A capacity and budget impact analysis in four Nordic countries

Objectives: This capacity and budget impact analysis considers implications of offering a more diversified benign prostate enlargement (BPE) surgical care offering from a healthcare payer perspective in Sweden, Denmark, Norway and Finland. Methods: A cohort simulation model compares 4-year treatment costs and capacity impact, including hospital bed-days and operating time, with Transurethral Resection of the Prostate (TURP), Holmium Laser Enucleation of the Prostate (HoLEP) using MOSES™Technology, photoselective vaporisation of the prostate (PVP) and Rezūm™ Water Vapour Therapy (WVTT). Current treatment choice is compared to a hypothetical scenario, where TURP-proportion is reduced to 50% and volumes of HoLEP, PVP and WVTT are increased. Deterministic sensitivity analysis (DSA) and probabilistic sensitivity analysis (PSA) considered uncertainty when varying all model inputs individually and simultaneously. Results: Reducing the proportion of TURP to 50% and shifting towards a more diversified surgical offering could save 590 bed-days, 2,281 theatre hours and SEK 14,020,153 in Sweden; 343 bed-days, 1,248 theatre hours and DKK 10,493,266 in Denmark; 267 bed-days, 1,032 theatre hours and NOK 9,329,844 in Norway and 576 bed-days, 1,181 theatre hours and 1,059,528€ in Finland per year. WVTT emerged as the lowest-cost procedure in all scenarios. Both DSAs and PSAs demonstrated outcome robustness. Conclusion: The adoption of a more diversified surgical care offering for patients with BPE in the Nordics may free theatre time and hospital bed-days and create meaningful cost-savings, which off-set higher initial device cost. Economic considerations should not constitute a barrier to the adoption of a patient-centric surgical care offering for BPE patients in the Nordics.