Introduction & Objectives
In recent years, several minimally invasive surgical treatments (MIST) for BPH have been proposed to achieve similar functional outcomes but better perioperative and sexual outcomes compared to traditional procedures. This study aimed to evaluate the usage trends and costs of different BPH surgical procedures over the last 10 years.
Materials & Methods
We conducted a retrospective analysis based on the PearlDiver™ Mariner database. It is a commercially available, all-payer claims, deidentified, U.S. database, containing over 41 billion Health Insurance Portability and Accountability Act (HIPAA)-compliant patient records collected between 2011 and 2022. Specific International Classification of Diseases (ICD) and Current Procedural Terminology (CPT) codes were used to identify population and outcomes in the database. The following data were described: number and type of BPH surgical procedures performed per year, total cost of care and mean cost per patient for each BPH surgical treatment. Reoperations were excluded. Traditional procedures (TURP, TUIP, HoLEP/ThuLEP, OSP, PVP) and MIST (PUL, LSP/RASP, Rezum, Aquablation, PAE) were distinguished. The data were extracted, categorized, synthesized, and analyzed directly by the R-based software integrated into to the database.
Results
A total of 274,808 patients undergoing BPH surgery were analyzed. TURP was the most common procedure (197,146; 71.7%). The other interventions were: HoLEP/ThuLEP (18,169; 6.6%), PUL (13,850; 5.0%), PVP (11,813; 4.3%), OSP (9,949; 3.6%), Rezum (9,852; 3.6%), LSP/RASP (6,362; 2.3%), TUIP (4,281; 1.6%), PAE (2,759; 1.0%), Aquablation (627; 0.2%). Total number of procedures significantly increased over the study period (2011-2014: 82,086 vs. 2015-2018: 86,528 vs. 2019-2022: 106,194; p<0.001). Overall utilization of traditional surgery remained stable (2011-2014: 81,906 vs. 2015-2018: 78,004 vs. 2019-2022: 81,448; p=0.089). The utilization of MIST significantly increased over time (2011-2014: 180 vs. 2015-2018: 8,524 vs. 2019-2022: 24,746; p<0.001) while remaining in each period considered significantly lower than traditional procedures (p<0.001). Over the study period, total cost for patients undergoing BPH surgery was $447.9M ($374.1M for traditional surgery + $73.3M for MIST). Mean cost per patient was 1.43 times higher for MIST than traditional procedures (p<0.001).
Conclusions
Traditional surgery for BPH remains the most common and its use appears stable over time, however, the number of MIST has progressively increased over the last decade. The total cost of care associated with traditional procedures is higher than those of MIST, but considering the individual patient the latter are paid more.
