Budget Impact of Minimally Invasive Surgical Treatments of Benign Prostatic Hyperplasia: An Analysis of 6 States With Limited New Technology Coverage

Prostatic urethral lift (PUL) and water vapor thermal therapy (WVTT) for benign prostatic hyperplasia (BPH) differ in treatment durability and cost of disposables, possibly leading to different long-term costs. This study compares the budget impact of PUL and WVTT for US payers in 6 states (Alabama, New Jersey, New York, Oregon, Pennsylvania, and Washington) over a 5-year time horizon. An Excel-based budget impact model was developed to estimate average total medical costs per patient of PUL and WVTT at years 1 and 5 for men with moderate-to-severe BPH. After undergoing an index procedure, men could experience adverse events (AEs) or retreatment while accumulating costs over time. Clinical inputs were derived from PUL and WVTT clinical trials while cost inputs were derived from 2021 Medicare reimbursement rates. At year 1, per-patient costs of PUL ranged from $5690 (Alabama) to $7323 (New Jersey) compared with year 1 costs of WVTT that ranged from $1829 (Alabama) to $2330 (New Jersey). The lower year 1 costs of WVTT stemmed from both lower procedural costs relative to PUL and better durability (lower costs associated with fewer retreatments and AEs). The cost differences between the 2 treatments continued to diverge in years 2 to 5. Through year 5, the cost savings associated with WVTT vs PUL ranged from $4383 (Alabama) to $5649 (New Jersey). Compared with PUL, the use of WVTT could potentially allow payers to cover BPH treatments for more members without compromising clinical outcomes or increasing budgets.