Holmium Laser Prostate Enucleation (HOLEP) Versus Trans-Urethral Resection of Prostate (TURP) in Treatment of Symptomatic Prostatic Enlargement; A Health Technology Assessment

Our aim was to compare the cost effectiveness of holmium laserprostate enucleation (HOLEP) versus trans-urethral resection of prostate. We searched all available databases for any controlled trialscomparing HOLEP and TURP from January 2000 to February 2009. Two independentreviewers studied and appraised the selected evidences. Then, effectiveness and costeffectiveness of HOLEP was evaluated. We identified four randomized controlled trials and one systematic review according to the inclusion criteria. Most of the studies had moderate quality ofevidence with limited sample sizes. Overall success rate of HOLEP was comparablewith TURP; but, some secondary outcomes such as pick flow rate twelve monthsafter the surgery was better in HOLEP. A comparison between the original costsand those obtained from sensitivity analysis showed that the cost parameters weresensitive to the number of the patients treated. Increasing the number of the patientsfrom 200 to 300 changed the study’s results in favor of the new techniques. Since the holmium and thulium laser sets are sensitive to the number of the patients and multipurpose, they potentially can be applied for stone fragmentation.Thus, utilization of these equipments will divide the costs between two groups ofthe services. In economic terms, these properties lower overhead costs and justifythe purchasing of these equipments.