Healthcare costs associated with benign prostatic hyperplasia

Dec. 21, 2023

The United States is facing a well-known healthcare cost crisis. In fact, healthcare costs represent a disproportionate amount of government expenditure, and Americans increasingly cite healthcare as their top financial concern, according to a 2017 GALLUP poll. For benign prostatic hyperplasia (BPH) specifically, the estimated yearly individual costs for treatment exceed $1,500, with national costs to the private sector approaching $4 billion, according to a study in The Journal of Urology.

For patients pursuing BPH surgery, there are myriad treatment options, each with varying complication rates, durability and convalescence. Among the various factors that patients and healthcare professionals consider when selecting a surgical intervention for BPH, the impact and influence of cost is significant yet understudied.

To this end, Kevin M. Wymer, M.D., a urologist at Mayo Clinic in Rochester, Minnesota, and a multidisciplinary team sought to evaluate private payer and patient out-of-pocket (OOP) costs associated with surgical treatment for BPH. The team used the OptumLabs Data Warehouse, which includes longitudinal data for commercially insured people and Medicare Advantage enrollees nationwide to identify patients with a BPH diagnosis who had a medical claim for a procedure of interest. These claims covered the following procedures: holmium laser enucleation of the prostate (HoLEP), transurethral resection of the prostate (TURP), photovaporization of the prostate (PVP), water vapor thermal therapy (WVTT), prostatic urethral lift (PUL) and simple prostatectomy (SP). Results from this study were published in Health Affairs.

The primary outcome was total healthcare cost (THC), which included both patient OOP and health plan-paid costs for the index procedure and combined follow-up during years one to five. The analysis ultimately included 25,407 patients with BPH, of whom 10,117 (40%) underwent TURP, 6,353 (25%) underwent PUL, 5,411 (21%) underwent PVP, 1,319 (5%) underwent SP, 1,243 (5%) underwent WVTT and 964 (4%) underwent HoLEP.

Overall, there was a significant variation in the costs associated with the surgical management of BPH. For aggregate index procedure and five-year follow-up costs, patients who underwent BPH surgery had an average additional cost of $20,318, of which $1,636 was OOP costs, relative to the non-BPH control group.

More specifically, there were significant variations in cost based on the index BPH procedure type. Although aggregate costs were similar among HoLEP, TURP, PVP and SP, differences emerged when separating index procedure and follow-up costs.

According to a 2021 study in The Journal of Urology, notable highlights include:

SP had the highest index procedure THC ($14,423) and the lowest 5-year follow-up THC ($19,962).
HoLEP had the third highest index THC ($7,412) and relatively low follow-up THC ($22,772).
For both HoLEP and SP, one potential explanation for the relatively high index procedure costs is that these procedures are more likely to be used in the treatment of very large glands (larger than 80 g).

Certainly, it can be expected that these patients may have more-complex initial management and higher costs. The low follow-up costs of these two interventions may correspond to high durability and low retreatment rates, which have been shown to help drive down costs, as evidenced in a 2011 study in The Journal of Urology. In contrast, PUL had significantly higher aggregate THC and patient OOP costs relative to those of all other procedures evaluated. This resulted from a combination of high index procedure THC ($8,170) and high follow-up THC ($26,103).

The group sees the study findings as a critical step toward the comprehensive assessment of surgical treatment options for BPH. "This study served as a starting point to give us the 10,000-foot view of patient- and system-level costs in the management of BPH. We hope that we can eventually translate this to individualized data to help patients make more-informed decisions, because unfortunately, we know that healthcare costs can have a big impact on our patients," says Dr. Wymer. Indeed, it is becoming apparent that OOP costs likely impact patient outcomes; however, little is known about financial toxicity in the BPH disease space.

Twenty-eight percent of patients with BPH reported at least moderate financial toxicity associated with their disease. Despite this, health professionals rarely address costs, commonly due to a lack of knowledge, according to a study in Nature Reviews Urology.

Ultimately, a better understanding of patient costs will support research regarding financial toxicity to allow for more-comprehensive treatment of patients with BPH. Coupled with clinical outcomes, patient quality of life data and individual patient preferences, these cost data can better inform patients and healthcare professionals as well as help guide policy decisions in the future.