Health technology assessment (HTA) of prostatic urethral lift (PUL) for the treatment of benign prostatic hyperplasia (BPH) in the Italian context.

Abstract

Background: Health technology assessment (HTA) is a process evaluating various aspects of healthcare technologies to support evidence-based decisions. Benign prostatic hyperplasia (BPH) is a common condition among aging men, significantly affecting QoL. Traditional treatments like transurethral resection of the prostate (TURP) and Holmium Laser Enucleation (HoLEP) are effective but often associated with complications and sexual dysfunction. The Prostatic Urethral Lift (PUL) system (UroLift) offers a minimally invasive alternative, preserving sexual function and ensuring faster recovery.

Methods: Using the EUnetHTA Core Model 3.0, UroLift was evaluated across nine domains, combining a systematic review of literature, expert consultation, and real-world evidence. A Budget Impact Model (BIM) simulated treatment pathways over five years, comparing UroLift with TURP and HoLEP.

Results: As the analysis shows, despite the higher initial acquisition cost, UroLift generates savings for the NHS in all the years considered within the analysis. Specifically, savings are derived from the lower incidence of adverse events and complications, both post-operative and in the long term, implying lower inpatient costs and less use of human resources. As anticipated, savings begin in the first year with a differential between the two scenarios considered at 57,747.40 and peak in the fifth year with savings of approximately €1.35 million, for a total estimated savings over the considered time horizon, considering the market shares, of €3,154,997.63.

Conclusions: UroLift demonstrates clinical efficacy, faster recovery, and sexual function preservation while generating cost savings, supporting its integration into BPH management pathways in Italy.