THE OXFORD LASER PROSTATE TRIAL - ECONOMIC-ISSUES SURROUNDING CONTACTLASER PROSTATECTOMY

Objective To compare the economic implications of transurethral resect ion of the prostate (TURF) and contact-laser vaporization of the prost ate (with the SLT system) using data obtained from a randomized contro lled trial. Methods All aspects of management before, during and after surgery on 102 patients, followed up for 3 months, were costed and an alysed. Based on the data from the trial, the mean costs were calculat ed. A sensitivity analysis was then performed to examine the effect of changes in some of the relevant variables, The mean difference in cos t between laser treatment and TURF was plotted against the cost of las er consumables, assuming a 5% re-operation rate for both operations at 5 years and a 5% discount rate. A range of laser re-operation rates w as compared with the mean difference in costs, assuming a hospital sta y of one night and two district-nurse visits. Other assumptions on dis counts and re-operation rates, based on collected data, were also test ed. Results TURP will remain more economical until the cost of laser c onsumables is reduced to 20% of the current list price, or a hospital stay of one night is introduced. Conclusions The costs of contact-lase r vaporization of the prostate are likely to exceed the costs of TURF unless laser treatment is accompanied by a more active approach to pos t-operative management, including a hospital stay of one night and, if necessary, the removal of the patient's catheter at home by a distric t nurse.