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Can we afford GreenLightTM vaporization in an accountable care system?
Eugene Cone, AB, Michael Maddox, MD, Sammy Elsamra, MD, Gyan Pareek, MD.
Brown University, Providence, RI, USA.

BACKGROUND: Benign prostatic hyperplasia (BPH) is an extremely common diagnosis encountered in a urologic practice. Although pharmacologic treatment is a mainstay in the treatment of BPH, surgical intervention is often necessary in cases of failed medical management. GreenLightTM laser vaporization and bipolar transurethral resection of the prostate (TURP) have been shown in the literature to be efficacious interventions in the treatment of patients with symptomatic BPH. We sought to compare institution-specific costs of each readily available treatment modality at the Miriam Hospital.
METHODS: The cost at our institution per case was estimated for GreenLightTM laser vaporization and bipolar TURP. At our institution, virtually all cases utilizing these two technologies are performed on an outpatient basis and therefore the analysis of costs were based on the assumption of a same-day surgical experience. Facility and physician costs were based on 2011 national averages for the specific intervention. At the Miriam hospital, the GreenLightTM is rented and thus the cost per case is based on a rental fee and cost of the laser, while the bipolar generator is placed in our operating room such that assuming a certain volume criteria per year is met, the bipolar cost per case is equivalent to the cost of each electrode. The use of more than one laser fiber or bipolar electrode per case is exceedingly rare and so the cost is based on the assumption that only one element is used per case. Statistical analysis was performed using two sample t-tests comparing the average cost per patient for GreenLightTM and bipolar TURP.
RESULTS: The Medicare facility and physician cost of GreenLightTM laser vaporization of the prostate are \,800 and \ respectively compared to bipolar TURP, which costs \,447 and \. The cost of each laser fiber is \ while the rental fee for each case is \. The Miriam hospital pays \ for a box of 12 bipolar electrodes translating to approximately \ per case. The average total cost per case for GreenLightTM vaporization versus bipolar TURP is \,063 and \ respectively. A summary of the costs for each modality is shown in Table 1.
CONCLUSIONS: Health care costs are a growing concern in today's economy, and annual direct and indirect costs of BPH have been estimated at over \ billion per year. Therefore, not only efficacy but cost are important variables to consider when employing a surgical treatment of BPH. Based on our model of laser rental and bipolar electrode costs, we found a statistically significant increased cost per patient with GreenLightTM laser vaporization versus bipolar TURP. It is possible that laser vaporization may be more appropriate for certain patients, but widespread application to the index BPH patient does not appear to be financially responsible at our institution.
Cost Analysis of BPH Surgical Modalities
GreenLightTMBipolar
Medicare Facility Cost\,800.00\,447.00
Medicare Physician Cost\.00\.00
Equipment/Case\.00\.00
Rental Fee/Case\.00n/a
TOTAL\,063.00\,520.00


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