Bipolar transurethral resection of the prostate (TURP) offers an economic benefit compared with monopolar TURP that follows from the clinical differences between the two procedures, concluded investigators who presented their findings at the 2017 Western Section of the AUA annual meeting in Vancouver, BC.
“Results of a number of clinical studies demonstrate the effectiveness of bipolar TURP and show that compared with monopolar TURP, the bipolar procedure is associated with lower rates of complications, including TUR syndrome, blood transfusions, and clot retention,” said senior author Christina L. Cool, MPH, manager of Life Sciences Consulting at Baker Tilly Virchow Krause, New York.
“To our knowledge, however, ours is the first U.S. cost analysis comparing bipolar and monopolar TURP, and its results show that bipolar TURP clearly provides cost savings. Technology such as bipolar TURP that improves care quality while reducing cost is inarguably a win for providers, payers, and patients.”
Cool and colleagues at Baker Tilly conducted the cost analysis using data extracted from the Medicare Inpatient and Outpatient Standard Analytic Files. It included 416 bipolar and 539 monopolar TURP procedures performed at 34 hospitals across the United States from January 2014 to September 2015. Equal representation of bipolar and monopolar physicians was selected from each geographic region.
The results showed that the bipolar procedure was associated with a per-patient savings of $668 when comparing its average total cost with that of monopolar TURP ($4,308 vs. $4,976). When the model excluded hospitals with substantially higher costs compared to the average, the average total cost per patient was $1,100 less for bipolar TURP compared with the monopolar procedure ($3,657 vs. $4,756).
“The cost savings achieved with bipolar TURP per patient is really quite substantial when considered relative to the overall total cost of these procedures, and the potential savings to health care systems and society is considerable taking into account the number of TURP procedures that are performed annually,” Cool said.
Several factors contribute to savings
Further analyses showed that numerous items contributed to the cost savings associated with the bipolar procedure. Bipolar TURP was performed significantly less often as an inpatient procedure compared with monopolar TURP (12.7% vs. 21.5%), which was important because overall index costs were 66% lower for outpatient versus inpatient cases. Cost breakdowns for inpatient cases showed total cost per patient was significantly lower for bipolar TURP than for monopolar TURP ($8,167 vs. $11,179). Main contributors to this difference were a significantly lower rate of intensive care unit admissions with bipolar TURP than with monopolar TURP (8% vs. 28%) as well as a significantly shorter inpatient hospital stay (3.5 vs. 5.0 days).
In addition, bipolar TURP conferred savings of between 22% and 48% in analyses of costs related to room and board, pharmacy, operating room, and laboratory.
There was no statistically significant difference in index outpatient costs between the bipolar and monopolar procedures when the analysis excluded “outlier hospitals,” defined as those with costs in the lower or upper quartiles.
Funding for the analysis was provided by Olympus Corporation of the Americas.
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