The use of Holmium and Tolmium YAG Laser-assisted technologies in benign prostatic hyperplasia surgery: A health technology assessment study

Background & Objectives: Current study aimed to compare effectiveness and cost effectiveness of laser devices in BPH surgery. This study could provide clear evidences which could be used in prior approval and funding of such new emerging technologies. Methods: A systematic search of related databases was performed to find Randomized clinical trials, systematic reviews, Meta analyses and health technology assessment studies which had been published up to ۲۰۰۸.key words are: Laser، Holmium YAG laser (HOLEP)، Tolmium Laser، Transurethral Resection of the Prostate (TURP) and prostate. Data for clinical effectiveness was retrieved from the literature. Two Laser Assisted Technologies were analyzed in terms of efficacy, effectiveness and cost-effectiveness and compared with Trans-Urethral Resection of the Prostate (TURP) method from the perspective of Iran Ministry of Health. We used standard costing for analysis of costs. One-way sensitivity analysis was performed for the examination of calculated ICER in different probable scenarios. Results: Literature review stressed that there is no statistically significant difference in clinical effectiveness of Lasers assisted devices and TURP technique. The length of hospital stay and severity of side effects are clinically and statistically lower in Laser Assisted devices. Estimated unit-cost of treatment for Tolmium, Holmium and TURP was ۳۴۰۳۵۴۱, ۳۰۱۹۲۶۱ and ۲۴۵۵۷۹۴ (RLS) from MOH perspective and ۳۴۰۳۵۴, ۴۷۱۹۲۶۱ and ۴۳۲۵۷۹۴ from societal perspective. Conclusion: Sensitivity analysis showed that, in most of the study scenarios TURP was dominant intervention because of low treatment costs. Tolmium laser only with the assumption of dual applicability and ۲۰۰ patients per year would be considered as a cost-effective technology.

Keywords:

Benign Prostatic Hyperplasia , Laser , Cost-effectiveness , TURP , ارزیابی فن آوری سلامت , هزینه – اثربخشی , TURP , بزرگی خوش خیم پروستات