Photoselective Laser Vaporization Prostatectomy Versus Transurethral Prostate Resection: A Cost Analysis

Purpose: Laser procedures to treat symptomatic benign prostatic hyperplasia are becoming more common despite concern for potentially increasing cost burdens often associated with new technologies. Materials and Methods: Actual costs associated with photoselective laser vaporization prostatectomy and transurethral prostate resection were measured using the EPSi™ and TSI (Eclipsys®) hospital cost accounting systems at 2 large tertiary referral centers for the first 12 months that GreenLight HPS™ was performed. Only patients who presented for photoselective laser vaporization prostatectomy or transurethral prostate resection as the principal treatment during the hospital visit were included in study. Results: A total of 250 men underwent transurethral prostate resection and 220 underwent photoselective laser vaporization prostatectomy, including 194 (78%) and 209 (95%), respectively, treated on an outpatient basis with less than 23 hours of hospitalization. Overall costs of laser vaporization were lower than those of transurethral prostate resection ($4,266 ± $1,182 vs $5,097 ± $5,003, p = 0.01). Average inpatient length of stay was also longer in the resection group. Conclusions: The actual costs of photoselective laser vaporization prostatectomy at our affiliated hospitals are lower than those of transurethral prostate resection. The primary reason is likely that most patients who undergo laser vaporization are treated on an outpatient basis compared to those who undergo resection. While significant complications are uncommon, those that prolong inpatient hospitalization such as hyponatremia (transurethral resection syndrome), which is associated with transurethral prostate resection but not with photoselective laser vaporization prostatectomy, can add substantial expense. Further studies are warranted to investigate these findings on a broader scale.