RESUMEN
PURPOSE: To perform a cost analysis of the current gold standard operation of Holmium Laser Enucleation of the prostate (HoLEP) compared to the new technique of water vapor thermal therapy with the Rezum™ system for the treatment of symptomatic benign prostatic hyperplasia (BPH). PATIENTS AND METHODS: Between October 2017 and January 2020, consecutive patients with invalidating lower urinary tract symptoms due to BPH who underwent Rezum™ and HoLEP procedures from the Aix regional hospital were identified. The outcome of each technique was assessed in terms of cost from the institutional perspective. Detailed expense reports based were provided by the accounts department of the hospital. These were used to compare in-hospital costs for each procedure. RESULTS: A total of 53 and 94 consecutive patients underwent respectively water vapor thermal therapy and HoLEP. The median costs for the surgical procedure were 1344 (IQR 1331-1361) and 669 (IQR 584-824), respectively for Rezum™ and HoLEP (median difference 675; P<0.001). The median costs of the hospital stay were 869 (IQR 869-869) for Rezum™ and 1295 (IQR 1295-1330) for HoLEP (median difference 426; P<0.001). Finally, the median total costs per patient were lower for HoLEP (2005 [IQR 1902-2150]) than for Rezum™ (2228 [IQR 2209-2243]) procedure, and the median difference of 233 was significant (P<0.001). CONCLUSIONS: One of the anticipated benefits of Rezum™, reduced length of hospital stay with an associated reduction in cost, did not materialize within this study. The patient's clinical condition and expectations should also be taken into account when deciding between Rezum™ and standard therapies. LEVEL OF PROOF: 3.