[Comparative analysis of photoselective vaporization of the prostate with the Greenlight laser and open prostatectomy for high volume prostate hypertrophy]

Abstract

Purpose: Comparative medical economic study between total prostatectomy and laser in the treatment of benign prostatic hyperplasia in patients whose prostate is more than 80g.

Materials and methods: This study compared data registered retrospectively for the group AVH and prospective data for PVP patients. The patients whose prostate weighed more than 80g by echography were selected. The adopted point of view was the one of the hospital and the temporal horizon was of one year after the surgical operation. Direct costs per- and post-surgery were taken into account including specific surgical care and secondary surgical revision. The medical data per- and postoperative were also compared. Primary outcome measure was incremental cost per procedure.

Results: Forty-one patients in the AVH group and 53 in the PVP group. The mean length of stay (LOS) is significantly shorter in the PVP group (3.0±1.0 days vs 10.4±4.0; P<0.001). Re-operation rate was significantly lower in the PVP group (1.9% vs 19.5% P<0.001). The cost analysis shows a mean additional cost of 1450 euros for the AVH group.

Conclusion: PVP was cost-effective because it was more economic and it lead to lower re-operation rate until one year of follow-up than in the AVH group. Nevertheless, these data deserve to be nuanced by unfavorable results of the AVH in comparison with those of the literature.

Keywords: Adenomectomy; Adénomectomie; Analyse coût–efficacité; Benign prostate hyperplasia; Cost analysis; Greenlight; Hypertrophie de la prostate; Laser.